US20210338444A1 - Methods and apparatuses for trialing a humeral head - Google Patents
Methods and apparatuses for trialing a humeral head Download PDFInfo
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- US20210338444A1 US20210338444A1 US17/373,235 US202117373235A US2021338444A1 US 20210338444 A1 US20210338444 A1 US 20210338444A1 US 202117373235 A US202117373235 A US 202117373235A US 2021338444 A1 US2021338444 A1 US 2021338444A1
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- mounting plate
- head
- plate
- trialing
- adapter
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Definitions
- This document pertains generally, but not by way of limitation, to systems and methods for planning and performing arthroplasty procedures. More particularly, this disclosure relates to, but not by way of limitation, intra-operative planning techniques for selecting the size of a prosthetic device component for a patient into which the prosthetic device component will be implanted.
- a shoulder joint comprises the juncture of the scapula, the clavicle and the humerus.
- the head of the humerus fits into a shallow socket of the scapula called the glenoid fossa to form a mobile joint.
- the humeral head moves in the glenoid fossa to provide a wide range of motion.
- the shoulder joint may suffer from various maladies including rheumatoid arthritis, osteoarthritis, rotator cuff arthropathy, avascular necrosis, bone fracture or failure of previous joint implants. If severe joint damage occurs and no other means of treatment is found to be effective, then shoulder reconstruction may be necessary.
- a shoulder joint prosthesis generally includes the replacement of the ball (glenosphere) of the humerus and, optionally, the socket (glenoid) of the shoulder blade with specially designed artificial components.
- the bio-kinematics, and thus the range of motion in the shoulder vary greatly among prospective patients for reconstruction shoulder surgery.
- the humeral component typically can have a metal shaft or stem with a body portion that can be embedded in the resected humerus and a generally hemispherical head portion supported on the stem. The head portion can slidingly engage a glenoid implant on the glenoid fossa.
- a shoulder prosthesis design can be readily adaptable to a wide range of bio-kinematics for prospective patients.
- shoulder prostheses are generally available as either unitary structures or modular components.
- unitary shoulder prosthesis a large inventory of differently sized prostheses must sometimes be maintained to accommodate the different bone sizes and joint configurations of the prospective patients.
- the patient can typically be evaluated by X-ray to determine approximate sizes of prostheses needed for reconstruction.
- a number of differently sized prostheses can be selected as possible candidates based upon this preliminary evaluation.
- Final selection of the appropriately sized prosthesis can be made during the surgery.
- each design can represent a compromise that is unable to achieve all of the natural range of motion of a healthy shoulder joint because of the fixed geometric configuration in their design.
- a humeral prosthesis can include two components: a humeral stem component and a spherical head releasably coupled to the stem.
- a three component design is known in which the stem and spherical head are interconnected with an adapter.
- a radial offset or angulator inclination of the head relative to the stem can be provided in individual components. Different radial offsets or angular inclinations are achieved through the use of different adapters or heads.
- conventional modular shoulder prosthesis kits can include multiple redundant components such as adapters and heads to achieve a range of prosthetic options.
- humeral head trialing devices are described in U.S. Pat. No. 8,647,387 to Winslow, U.S. Pat. No. 7,431,736 to Maroney et al., U.S. Pat. No. 6,736,852 to Callaway et al., U.S. Pat. No. 6,673,114 to Hartdegen et al., and U.S. Pub. No. 2016/0030187 to Sperling et al.
- a problem to be solved relates to the need for surgeons to have to select a proper size and manually adjust the location and orientation of a humeral head and a corresponding humeral head trial, which can typically involve the movement of several components that are intricately attached to each other, in order to select a properly-sized unitary or modular shoulder prosthesis. These components typically can be manually held together in place in order to make the proper reading of the size of the humeral head trial. Thus, the surgeon can be left with needing to make several estimates of the humeral head size while holding the components in place.
- the present subject matter can help provide a solution to various problems associated with the trialing of a humeral head by providing a trialing assembly that can be used to couple humeral stems or humeral adapters with multiple humeral head trials.
- the trialing assembly can be locked in place without removing the humeral head trial from the anatomy to ensure accurate readings are taken from the assembly and a proper head size is selected.
- the trialing assembly can be easily assembled and disassembled, cleaned and reused, thereby minimizing the number of components and instruments that must be maintained in inventory.
- the present subject matter can help provide a solution to this problem, such as by providing a system for aligning a prosthetic head implant with a prosthetic stem that can comprise a mounting plate, a first fastener and an adapter coupling plate.
- the mounting plate can comprise: a first major surface; a second major surface opposing the first major surface; an adapter accommodation hole extending through from the first major surface to the second major surface; and sizing indicia located on the second major surface.
- the first fastener can extend from the mounting plate.
- the adapter coupling plate can be slidably engaged with the mounting plate and can comprise: a third major surface facing in a direction of the first major surface; a fourth major surface opposing the third major surface; an adapter coupling hole extending through from the third major surface to the fourth major surface, the adapter coupling hole surrounded by the adapter accommodation hole; and an indicator located on the fourth major surface to point to various portions of the sizing indicia as the adapter coupling plate slides against the mounting plate at the first slot.
- a system for aligning a prosthetic head implant with a prosthetic stem can comprise: a mounting plate, a slide post, a prosthetic head and an adapter coupling plate.
- the slide post can extend through the mounting plate in an adjustable manner.
- the prosthetic head can be stationarily coupled to the mounting plate and have an access hole aligned with the slide post.
- the adapter coupling plate can be slideably engaged with the mounting plate via the slide post. The slide post can be adjusted from an exterior of the prosthetic head component through the access hole to immobilize the adapter coupling plate relative to the mounting plate.
- a system for aligning a prosthetic head component with a prosthetic stem can comprise: a mounting plate; a fastener, a prosthetic head, an adapter coupling plate and a tongue and groove system.
- the fastener can extend from the mounting plate in an adjustable manner.
- the prosthetic head can be stationarily coupled to the mounting plate and have an access hole aligned with the fastener.
- the tongue and groove system can slideably connect the mounting plate and the adapter coupling plate. The fastener can be adjusted from an exterior of the prosthetic head component through the access hole to immobilize the adapter coupling plate relative to the mounting plate.
- a method for aligning a prosthetic head component with a prosthetic stem can comprise: attaching a mounting plate of a trialing device to a prosthetic head component, the trialing device further including an adapter coupling plate; inserting a neck of a prosthetic stem into the adapter coupling plate; sliding the mounting plate of the trialing device relative to the adapter coupling plate to a adjust a position of the prosthetic head component relative to the neck of the prosthetic stem; and from outside of the prosthetic head, adjusting a fastener connected to the mounting plate to immobilize a position of the adapter coupling plate to lock the position.
- FIG. 1 is a front perspective view of a total shoulder arthroplasty system in which a humerus bone includes a humeral head prosthetic device system.
- FIG. 2 is a schematic illustration of the humeral head prosthetic device system of FIG. 1 implanted in a humerus bone and showing a coupling device connecting a prosthetic head with a humeral adapter and a humeral stem.
- FIGS. 3A and 3B are lateral and medial exploded views of a trialing device for use as or selection of the coupling device of FIG. 2 showing a trialing head, a mounting plate and an adapter coupling plate.
- FIG. 4 is a flow chart of the humeral head prosthetic device system of FIG. 2 showing a conversion ring for use as the coupling device and connecting the prosthetic head with the humeral adapter and the humeral stem.
- FIG. 5 is a front view of a humeral head template used to initially size a humeral head trial or prosthetic.
- FIG. 6 is a perspective view of the trialing device of FIGS. 3A and 3B assembled with the trialing head and showing the adapter coupling plate connected to the mounting plate via a pair of slide posts.
- FIG. 7 is a schematic perspective view of the trialing head of FIG. 6 coupled to a humeral adapter implanted into a humerus bone illustrating multiple degrees of freedom of movement.
- FIG. 8 is a perspective view of an exterior of the trialing head of FIG. 7 showing a driver instrument adjusting one of the slide posts.
- FIG. 9 is an interior side view of the trialing device of FIGS. 6-8 after adjustment showing an indicator aligning with sizing indicia.
- FIG. 10 is a perspective view of another embodiment of a humeral head trialing device for use with the humeral head prosthetic device system of FIG. 4 wherein a slide plate includes slots for receiving rails of a bushing.
- FIG. 11 is a bottom plan view of the humeral head trialing device of FIG. 10 showing an embodiment of an offset slide device within a trialing head.
- FIG. 12A is a cross-sectional view of the humeral head trialing device of FIG. 11 taken along a center of the device to show the offset slide device having a trialing head, a slide plate, a bushing and a set screw.
- FIG. 12B is a perspective cross-sectional view of the humeral head trialing device of FIG. 11 taken offset from a center of the device to show a bushing rail.
- FIG. 13 is a perspective view of the humeral head trialing device of FIGS. 10-12B mounted on a humerus bone and a drive instrument positioned to engage rotational features of the trialing head.
- FIG. 14A is an exploded view of an alternative embodiment of the humeral head trialing device of FIGS. 10-12B wherein the bushing includes slots for receiving rails of the slide plate.
- FIG. 14B is a perspective view of a trialing head used in the humeral head trialing device of FIG. 14A showing a well and a socket for receiving the bushing and slide plate.
- FIG. 14C is a cross-sectional view of the humeral head trialing device of FIG. 14A showing interacting forces generated by a fastener.
- FIG. 15A is a top perspective view of another embodiment of a humeral head trialing device for use with the humeral head prosthetic device system of FIG. 4 .
- FIG. 15B is a bottom perspective view of the humeral head trialing device of FIG. 15A showing another embodiment of an offset slide device within a trialing head.
- FIG. 16 is a top perspective view of a first embodiment of the offset slide device including a trial offset plate, trial offset slide and a locking screw.
- FIG. 17 is a top perspective view of a second embodiment of the offset slide device including a trial offset plate and a trial offset slide with a bushing.
- FIG. 18 is a bottom perspective view of a third embodiment of the offset slide device including a trial offset plate and a trial offset slide with a projection feature.
- FIG. 19 is a bottom view of the trialing head of FIGS. 15A and 15B showing a trial mechanism well, gripping features, anti-rotation features and retention features.
- FIG. 20A is a partially exploded view of the humeral head trialing device of FIGS. 15A and 15B showing the offset slide device of FIGS. 15 and 16 positioned relative to the trial mechanism well of the trialing head of FIGS. 15 and 19 .
- FIG. 20B is a perspective view of the humeral head trialing device of FIGS. 15A and 15B showing the offset slide device of FIG. 20A inserted into the trial mechanism well.
- FIG. 20C is a bottom plan view of the humeral head trialing device of FIGS. 15A and 15B showing the trial offset slide translated within a groove of the trial offset plate to expose a fastener channel.
- FIG. 20D is a perspective view of the humeral head trialing device of FIGS. 15A and 15B showing the offset slide device aligned with a neck of a humeral stem.
- FIG. 20E is a front plan view of the humeral head trialing device of FIGS. 15A and 15B attached to the humeral stem to illustrate rotational and translational movement capabilities of the trialing head.
- FIG. 20F is a front plan view of the humeral head trialing device of FIGS. 15A and 15B showing the trialing head rotated and translated from the position of FIG. 20E .
- FIG. 1 is a front perspective view of total shoulder arthroplasty system 10 comprising implanted prosthetic glenoid 12 and implanted humeral head prosthetic device system 14 .
- Prosthetic glenoid 12 can include glenoid 16 and humeral head prosthetic device system 14 can include humeral head 18 .
- Glenoid 16 can be secured to scapula bone S using any suitable means, such as a center post and a plurality of peripheral posts.
- Humeral head 18 can be secured to humerus bone H via coupling device 24 that connects to a humeral adapter 28 coupled to humeral stem 30 , as shown in FIG. 2 .
- Scapula bone S and humerus bone H are typically reamed, resected or otherwise prepared to receive glenoid 16 and humeral head 18 .
- humeral head 18 can be mounted to humerus bone H such that the perimeter 20 of humeral head 18 can be substantially aligned with edge 22 of humerus bone H. It can be desirable for humeral head 18 to be properly centered on humerus bone H to achieve correct anatomic operation, for example, so that humeral head 18 can smoothly rotate against glenoid 16 . As such, the size of humeral head 18 can be selected so that the diameter of perimeter 20 substantially matches that of edge 22 .
- humeral head 18 it is not, however, always possible for humeral head 18 to be optimally aligned with edge 22 upon implantation.
- humeral stem 30 and humeral adapter 28 ( FIG. 2 ) are not always implanted into humerus bone H such that the neck (e.g., neck 98 A of FIG. 4 ) for receiving humeral head 18 is centered to align with glenoid 16 .
- the present disclosure provides a system and method for sizing, trialing and aligning humeral head 18 with humerus bone H.
- FIG. 2 is a schematic illustration of a humeral head prosthetic device system, such as system 10 of FIG. 1 , implanted in humerus bone H and showing coupling device 24 connecting prosthetic head 26 with humeral adapter 28 and humeral stem 30 .
- Humerus bone H can be reamed to accept humeral stem 30 in any suitable manner.
- Humeral stem 30 can include a socket for receiving humeral adapter 28 .
- Humeral adapter 28 can include neck 32 for connecting to coupling device 24 .
- Coupling device 24 can be inserted into prosthetic head 26 at socket 34 .
- Prosthetic head 26 can comprise or be substituted for humeral head 18 of FIG. 1 .
- coupling device 24 can have a socket for neck 32 that is offset from the center of coupling device 24 .
- socket 34 in prosthetic head 26 can be offset from the center of prosthetic head 26 .
- combinations of offset components can be used, as is discussed with reference to FIG. 4 .
- Trialing device 36 FIGS. 3A and 3B ) can be used to select a prosthetic head 26 and a compatible coupling device 24 .
- coupling device 24 can comprise trialing device 36 .
- FIGS. 3A and 3B are lateral and medial exploded views of trialing device 36 for use as, or selection of, coupling device 24 of FIG. 2 , which shows trialing head 38 , mounting plate 40 and adapter coupling plate 42 .
- Trialing head 38 can comprise curved articulating surface 44 , edge perimeter 46 , interior surface 48 , socket 50 and access openings 52 A and 52 B.
- Mounting plate 40 can comprise first major surface 54 , second major surface 56 , adapter accommodation hole 58 and indicia 60 .
- Slide posts 62 A and 62 B can extend from and/or through mounting plate 40 .
- Adapter coupling plate 42 can comprise third major surface 64 , fourth major surface 66 , adapter coupling hole 68 and indicator 70 .
- Curved articulating surface 44 can be shaped to approximate the shape of a natural or anatomic humeral head. Curved articulating surface 44 can be smooth and can have a center that substantially aligns with the center of trialing head 38 , which can comprise the center of edge perimeter 46 , which can be circular. Interior surface 48 can be flat and can be configured to face towards or abut a planar resection of humerus bone H. Trialing head 38 can include recess 72 that can allow edge perimeter 46 to extend out past socket 50 to envelop or partially cover portions of humeral adapters 28 A and 28 B ( FIG. 4 ).
- Mounting plate 40 can be inserted into socket 50 such that first major surface 54 faces toward access openings 52 A and 52 B and can thus be disposed inside of trialing head 38 .
- socket 50 can include magnets 73 that assist with retaining mounting plate 40 within trialing head 38 .
- First major surface 54 can be flat to abut against surface 74 inside socket 50 .
- Socket 50 can be sized and configured to provide a frictional fit with the outer perimeter of mounting plate 40 that joins first major surface 54 and second major surface 56 .
- the outer perimeter of mounting plate 40 can include flats 75 A and 75 B that can engage with corresponding flat surfaces of socket 50 to prevent rotation.
- Slide posts 62 A and 62 B can extend through mounting plate 40 so as to project therefrom.
- mounting plate 40 can include post holes 76 A and 76 B that can allow slide posts 62 A and 62 B to extend through mounting plate 40 .
- Slide posts 62 A and 62 B can include heads 78 A and 78 B, shafts 80 A and 80 B and stops 82 A and 82 B, respectively.
- Post holes 76 A and 76 B can be threaded to mate with corresponding threading on shafts 80 A and 80 B.
- Stops 82 A and 82 B can be nuts or washers and/or can be affixed to shafts 80 A and 80 B, respectively, in a stationary manner, such as by welding.
- a driver instrument e.g., a screw driver or driver instrument 118 of FIG. 8
- a driver instrument can engage a drive socket in head 78 A to rotate shaft 80 A and to cause slide post 62 A to move relative to post hole 76 A via the threaded engagement.
- shaft 80 A can be advanced into post hole 76 A to move stop 82 A away from second major surface 56 or can be retreated from post hole 76 B to move stop 82 A toward second surface 56 .
- Slide post 62 B can operate in a similar manner.
- stops 82 A and 82 B can be used to pull adapter coupling plate 42 into compression with mounting plate 40 to thereby immobilize adapter coupling plate 42 relative to mounting plate 40 .
- Third major surface 64 of adapter coupling plate 42 can be positioned against second major surface 56 of mounting plate 40 .
- Adapter coupling plate 42 can include slots 84 A and 84 B that can align with post holes 76 A and 76 B, respectively.
- Slots 84 A and 84 B each have a major axis and a minor axis.
- the minor axes can be slightly longer than the width of slide posts 62 A and 62 B, thereby limiting side-to-side (relative to the orientation of FIG. 3A ) movement of adapter coupling plate 42 , and can be less than the width of stops 62 A and 62 B, thereby preventing slide posts 62 A and 62 B from withdrawing from slots 84 A and 84 B.
- the major axes can be longer than the width of slide posts 62 A and 62 B, thereby permitting up-and-down (relative to the orientation of FIG. 3A ) movement of adapter coupling plate 42 .
- Adapter coupling hole 68 can align with adapter accommodation hole 58 .
- Adapter coupling hole 68 can be sized and configured to mate with neck 98 A or neck 98 B of humeral adapter 28 A and humeral adapter 28 B, respectively, of FIG. 4 .
- Adapter coupling hole 68 can be typically round in shape and can form wall 86 to receive the desired neck.
- wall 86 can be flat and straight such that coupling hole 68 is cylindrical.
- wall 86 can be flat and angled such that coupling hole 68 is conical in shape.
- wall 86 can be arcuate such that coupling hole 68 is hemi-spherical in shape.
- Adapter accommodation hole 58 can be larger than adapter coupling hole 68 . As such, a neck extending through adapter coupling hole 68 and into adapter accommodation hole 58 can be moved around within the area of adapter accommodation hole 58 as adapter coupling plate 42 slides against mounting plate 40 .
- adapter coupling plate 42 When trialing device 36 is assembled, adapter coupling plate 42 can slide against mounting plate 40 to change the position of trialing head 38 relative to coupling hole 68 .
- Adapter coupling plate 42 can slide along slide posts 62 A and 62 B at slots 84 A and 84 B to change the position of the center of curved articulating surface 44 relative to the center of coupling hole 68 , thereby changing the offset of trialing device 36 .
- the position of coupling hole 68 In the orientation shown, the position of coupling hole 68 is changed in the up-and-down direction (relative to the orientation of FIG. 3A ).
- Trialing device 36 can be rotated about the neck that is inserted in coupling hole 68 to allow the position of coupling hole 68 to be changed in the side-to-side direction (relative to the orientation of FIG. 3A ).
- the relative position between adapter coupling plate 42 and mounting plate 40 can be marked, identified or shown using indicia 60 and indicator 70 .
- indicator 70 can be any feature or marking that provides a constant frame of reference on adapter coupling plate 42 and that overlaps or otherwise interacts with indicia 60 .
- indicator 70 comprises an edge of flange 87 on adapter coupling plate 42 that overlaps with hash marks defining indicia 60 .
- Each of the hash marks can correspond to an offset size of a prosthetic humeral head.
- size A can correspond to a zero offset where the center of coupling hole 68 aligns with the center of curved articulating surface 44 , with sizes B-F indicating progressively larger offsets.
- Indicator 70 can include marker 88 that prompts a user where to look to take the size reading.
- marker 88 comprises an arrow pointing to the edge of flange 87 that overlaps with indicia 60 .
- FIG. 4 shows an installation relationship of humeral head prosthetic device system 10 of FIGS. 1 and 2 showing conversion ring 90 for use as coupling device 24 and connecting prosthetic head 26 with humeral adapters 28 A or 28 B and humeral stem 30 .
- Humeral stem 30 can comprise shank 92 and socket 94 .
- Humeral adapter 28 A can comprise post 96 A and neck 98 A and can be configured as a fixed angle adapter.
- Humeral adapter 28 B can comprise post 96 B and neck 98 B and can be configured as a variable angle adapter.
- Conversion ring 90 can comprise body 100 having neck bore 102 .
- Prosthetic head 26 can comprise outer surface 104 , inner surface 106 and socket 108 .
- Humeral stem 30 can be configured in a conventional manner to be implanted into cancellous bone of a long bone.
- humeral stem 30 is configured to be implanted into a humerus bone wherein the humeral head has been resected.
- Shank 92 can be inserted into the cancellous bone to anchor stem 30 within the bone in a stationary fashion.
- Socket 94 can remain exposed to receive one of adapters 28 A and 28 B, which are configured to mate with conversion ring 90 .
- Posts 96 A and 96 B can be configured similar to each other so as to mate with socket 94 of humeral stem 30 such that adapters 28 A and 28 B comprise modular alternatives for use with humeral stem 30 .
- posts 96 A and 96 B have an oblong shape that mates with a similarly oblong shaped socket 94 . The mating oblong shapes prevent rotation of posts 96 A and 96 B in stem 30 .
- Necks 98 A and 98 B extend from posts 96 A and 96 B, respectively, at fixed angles in order to initially set prosthetic head 26 at a fixed angle relative to stem 30 .
- an axis extending along the center of post 96 A is at a fixed angle relative to an axis extending along the center of neck 98 A, thereby locating the axis of neck 98 A in a fixed relationship to an axis extending along the center of shank 92 .
- Humeral adapter 28 B can be configured in a similar manner.
- humeral stem 30 can be made monolithically with either of adapters 28 A and 28 B so as to form a one-piece humeral stem component.
- a one-piece humeral stem component or an adapter can include a Morse taper in place of necks 98 A and 98 B.
- Neck 98 B can comprise a variable angle neck such that the angle between prosthetic head 26 and shank 92 can be slightly adjusted once stem 30 , adapter 28 B and conversion ring 90 are assembled. As such, the wall surfaces of neck 98 B can be curved to engage curved surfaces of neck bore 102 of an embodiment of conversion ring 90 different from the one shown in FIG. 4 .
- Conversion ring 90 comprises a component that allows prosthetic head 26 to mate with adapters 28 A and 28 B.
- Side surfaces 110 of body 100 can be shaped to match the shape of socket 108 of prosthetic head 26 .
- Socket 108 and side surfaces 110 can have an asymmetric shape to prevent rotation between conversion ring 90 and prosthetic head 26 .
- a central axis A B of body 100 can be offset from a central axis A S 102 of socket 102 .
- different conversion rings 90 can be configured with different offset distances D O to position prosthetic head 26 in different locations relative to stem 30 for different situations, such as depending on the implantation of stem 30 into the cancellous bone and the particular humeral head anatomy and mating glenoid anatomy or prosthetic.
- Trialing device 36 can be used to determine the desired conversion ring 90 to be used in a particular implant system. Trialing device 36 can alternatively be used in place of conversion ring 90 due to the ability of adapter coupling plate 42 being able to equivalently shift the location of axis A S relative to axis A B . Different prosthetic heads can be coupled to conversion ring 90 to match or closely mimic the anatomy of a patient.
- socket 108 of prosthetic head 26 is sized and shaped to fit with side surfaces 110 of conversion ring 90 .
- Socket 108 can be deep enough to receive the entire thickness of conversion ring 90 such that inner surface 106 can be positioned in close proximity to a resected humeral surface.
- Prosthetic head 26 can include outer surface 104 that can be curved or arcuate to mate with an anatomic or prosthetic glenoid cavity. Outer surface 104 defines the geometry of prosthetic head 26 .
- prosthetic head 26 can have, in different embodiments, different thicknesses T, different diameters D and different radii R.
- a surgeon can intraoperatively select from among a plurality of different sized prosthetic heads 26 to find a prosthetic head that closely matches the anatomy of a particular patient.
- FIG. 5 is a front view of humeral head template 114 used to initially size a humeral head trial or prosthetic, such as the exemplary humeral head 18 of FIG. 1 , prosthetic humeral head 26 of FIG. 2 or trialing humeral head 38 of FIGS. 3A and 3B .
- Template 114 includes slots 116 A- 116 P that have different geometries, such as thicknesses, diameters and radii.
- the resected bone portion is positioned within different slots 116 A- 116 P in order to find the initial size of a head component that can be implanted into a that particular patient. For example, a surgeon can select which of slots 116 A- 116 P the resected humeral head matches closest. That particular slot can, for example, indicate to the surgeon the thickness T, diameter D and radius R of a prosthetic head 26 that can be used to closely match the anatomy of the patient.
- FIG. 6 is a perspective view of trialing device 36 of FIGS. 3A and 3B assembled with trialing head 38 and showing adapter coupling plate 42 connected to mounting plate 40 via slide posts 62 A and 62 B.
- Trialing head 38 can be selected to match the geometry of the resected humeral head determined using template 114 .
- Mounting plate 40 can be inserted into trialing head 38 to secure components of trialing device 36 thereto. For example, the outer perimeter of mounting plate 40 can be inserted into socket 50 of trialing head 38 via an interference or friction fit.
- Slide posts 62 A and 62 B can be retracted further out of post holes 76 A and 76 B to permit adapter coupling plate 42 to slide relative to mounting plate 40 in slots 84 A and 84 B, respectively.
- a humeral adapter such as one of adapters 28 A and 28 B of FIG. 4
- a humeral adapter such as one of adapters 28 A and 28 B of FIG. 4
- coupling plate 42 can be slid against mounting plate 40 to move edge perimeter 46 relative to resected humeral bone, as shown in FIG. 7 .
- FIG. 7 is a perspective view of trialing head 38 of FIG. 6 coupled to a humeral adapter (not shown for clarity) implanted into humerus bone H and illustrates multiple degrees of freedom of movement.
- Humeral stem 30 can be implanted into humerus bone H in a conventional manner.
- Humeral adapter 28 A or 28 B can be connected to humeral stem 30 , as previously described.
- Adapters 28 A or 28 B can be used to couple trialing head 38 to trialing device 36 .
- post 96 A of adapter 28 A can be inserted into humeral stem 30 and neck 98 A of adapter 28 A can be inserted into coupling hole 68 of adapter coupling plate 42 .
- Surgeon S can move trialing head 38 in multiple directions by sliding of plates 40 and 42 relative to each other and by rotating adapter coupling plate 42 about an axis of neck 98 A.
- edge perimeter 46 of trialing head 38 can be moved relative to edge 22 of humerus bone H to position trialing head 38 in the proper position.
- the center of trialing head 38 can be positioned in the center of the resected surface of humerus bone H so that edge perimeter 46 is concentric with edge 22 .
- the position of trialing head 38 relative to humerus bone H can be marked on humerus bone H using an appropriate marker.
- an appropriate marker for example, as shown in FIG. 8 , the location of marker 117 on trialing head 38 can be marked on humerus bone H using a surgical marker or a electrocautery, e.g. a Bovie.
- marker 117 can extend through trialing head 38 , or have a corresponding mark on the opposite side, so as to be visible to a surgeon from both sides of trialing head 38 .
- Marker 117 can allow the surgeon to reassemble trialing head 38 to trialing device 36 or reposition trialing head 38 on trialing device 36 into the same position on the marked-up humerus bone H if for some reason trialing head 38 had to be removed or trialing device 36 needed to be repositioned.
- FIG. 8 is a perspective view of an exterior of trialing head 38 of FIG. 7 showing slide post 62 A and driver instrument 118 inserted into articulating surface 44 to adjust slide post 62 B.
- Trialing head 38 includes access openings 52 A and 52 B that permit driver instrument 118 to enter the interior region of trialing head 38 to access slide posts 62 A and 62 B.
- Heads 78 A and 78 B of slide posts 62 A and 62 B can be positioned within trialing head 38 via mounting plate 40 to align with access openings 52 A and 52 B.
- Slide posts 62 A and 62 B can be rotated to tighten trialing device 36 so that the position of trialing head 38 relative to coupling plate 42 does not change. For example, with reference to FIG.
- slide posts 62 A and 62 B can be tightened such that stops 82 A and 82 B pull coupling plate 42 into compression with mounting plate 40 , preventing coupling plate 42 from sliding against mounting plate 40 .
- FIG. 8 shows trialing device 36 having a pair of slide posts 62 A and 62 B
- other examples of trialing devices of the present application can be immobilized using only a single slide post.
- coupling plate 42 and mounting plate 40 can be configured to slide relative to each other in other arrangements in which slide posts 62 A and 62 B are not used.
- coupling plate 42 can be configured to slide directly within a slot in mounting plate 40 , and a separate fastener can be used to lock the relative positions of the plate.
- coupling plate 42 can be immobilized relative to mounting plate 40 via a deformable body that can be deformed via slide posts 62 A and 62 B.
- stops 82 A and 82 B could be replaced with deformable sleeves that can slide within slots 84 A and 84 B respectively.
- Slide posts 62 A and 62 B can be sized to be threaded or inserted into the deformable sleeves to radially expand the deformable sleeves to push them against slots 84 A and 84 B, thereby immobilizing coupling plate 42 .
- other types of deformable bodies may be activated by one or more slide posts to frictionally engage coupling plate 42 and mounting plate 40 with each other.
- FIG. 9 is an interior side view of trialing device 38 of FIGS. 6-8 after adjustment, where an edge of flange 87 aligns with sizing indicia 60 .
- edge 120 of flange 87 can align with hash marks 122 A- 122 F to indicate the size of prosthetic to be used with the patient.
- edge 120 of flange 87 aligns with hash mark 122 C, indicating that a size C prosthetic humeral head can be used.
- size C can be offset from a zero offset position indicated by hash mark 122 A.
- more or fewer sizes/hashmarks can be indicated on mounting plate 40 .
- other types of sizing indicia or indicators can be used. For example, marks along the edges of coupling plate 42 along slots 84 A and 84 B can be used to align with hash marks along the sides of mounting plate 40 .
- the present subject matter can help provide a solution to various problems associated with the trialing of a humeral head by providing trialing device 36 , or a similar device such as those discussed below with reference to FIGS. 10-20F , that can be used to couple humeral stem 30 or humeral adapters 28 A and 28 B with multiple humeral head trials, such as such as humeral head 18 of FIG. 1 , prosthetic head 26 of FIG. 2 or trialing head 38 of FIGS. 3A and 3B .
- the trialing devices described herein can be locked in place without removing the humeral head trial from the anatomy, such as by rotating slide posts 62 A and 62 B from the exterior of trialing head 38 for trialing device 36 to ensure accurate readings are taken from indicator 70 and sizing indicia 60 and a proper head size is selected.
- the trialing devices described herein can be easily assembled and disassembled, cleaned and reused, thereby minimizing the number of components and instruments that must be maintained in inventory.
- FIG. 10 is a perspective view of humeral head trialing device 130 for use with humeral head prosthetic device system 10 of FIG. 4 .
- FIG. 11 is a bottom plan view of humeral head trialing device 130 of FIG. 10 showing offset slide device 132 within trialing head 134 .
- Humeral head trialing device 130 is similar to humeral head trialing device 36 of FIGS. 3A and 3B except, for example, humeral head trialing device 130 includes only a single fastener for locking offset slide device 132 and humeral head trialing device 130 slides on rails rather than posts.
- Trialing head 134 can comprise curved articulating surface 136 , edge perimeter 138 , interior surface 140 , socket 142 , access opening 144 and sockets 146 A and 146 B.
- Offset slide device 132 can include slide plate 148 and bushing 150 .
- Slide plate 148 and bushing 150 can be coupled together using fastener 152 .
- Slide plate 148 and bushing 150 can operate in a similar fashion as mounting plate 40 and adapter coupling plate 42 of humeral head trialing device 36 , respectively.
- bushing 150 can include rails that are captured within channels of slide plate 148 .
- slide plate 148 can be inserted into recess 180 of trialing head 134 and can be held in place by frictional interaction between slide plate 148 and trialing head 134 at recess 180 .
- Fastener 152 can be extended into access opening 144 to engage fastener bore 164 ( FIG. 12A ) in slide plate 148 to prevent slide plate 148 from separating from trialing head 134 .
- Bushing 150 can slide between trialing head 134 and slide plate 148 such that indicators 156 A and 156 E can align with size indicia 158 A and 158 E on slide plate 148 .
- Fastener 152 can be adjusted to pull slide plate 148 toward trialing head 134 to immobilize bushing 150 .
- FIG. 12A is a cross-sectional view of humeral head trialing device 130 of FIG. 11 showing offset slide device 132 having trialing head 134 , slide plate 148 , bushing 150 and fastener 152 .
- FIG. 12B is a perspective cross-sectional view of humeral head trialing device 130 of FIG. 11 taken offset from a center of the device to show rail 176 B.
- Slide plate 148 can comprise fifth major surface 160 , sixth major surface 162 , fastener hole 164 , first slot 166 A and second slot 166 B (not visible in FIGS. 12A and 12B ), and aperture 167 .
- Bushing 150 can comprise first end surface 168 , second end surface 170 , adapter coupling hole 172 , flanges 174 , rails 176 A (not visible in FIGS. 12A and 12B ) and 176 B and ledge 177 . End surfaces 168 and 170 can be considered the major surfaces of bushing 150 .
- Bushing 150 can comprise a rectilinear body having four sides bounded by first end surface 168 and second end surface 170 . Rails 176 A and 176 B can extend from opposite sides of the rectilinear body to engage slots 166 A and 166 B.
- Flanges 174 can extend from first end surface 168 to surround socket 178 , which can extend through the rectilinear body from second end surface 170 through to first end surface 168 .
- Flanges 174 can be separated by scallops or cut-outs 175 in bushing 150 .
- Flanges 174 can comprise resilient bodies that are separated by cut-outs 175 to facilitate flexion to increase frictional engagement with neck 98 A or 98 B.
- Curved articulating surface 136 can be shaped to approximate the shape of a natural or anatomic humeral head. Curved articulating surface 136 can be smooth and can have a center that substantially aligns with the center of trialing head 134 , which can comprise the center of edge perimeter 138 , which can be circular. Interior surface 140 can be flat and can be configured to face towards or abut a planar resection of humerus bone H. Interior surface 140 can be smooth or textured. Texturing 141 of interior surface 140 can facilitate locking of trialing head 134 into place via friction with the humerus bone H, thereby preventing trialing head 134 from migrating out of position once aligned.
- the texturing 141 can comprise knurling, pointed projections, spikes, pyramids and the like.
- Trialing head 134 can include recess 180 that can engage slide plate 148 in order to allow edge perimeter 138 to extend out past socket 142 and slide plate 148 to envelop or partially cover portions of humeral adapters 28 A and 28 B ( FIG. 4 ).
- Slide plate 148 can be inserted into socket 142 at recess 180 such that fifth major surface 160 faces toward access opening 144 and can thus be disposed inside of trialing head 134 .
- socket 142 can include magnets (e.g., magnets 73 of FIG. 3B or magnets 280 A and 280 B of FIG. 19 ) that assist with retaining slide plate 148 within trialing head 134 .
- Fifth major surface 160 can be flat to abut against surface 182 inside socket 142 .
- Recess 180 can be sized and configured to provide a frictional fit with the outer perimeter of slide plate 148 that joins fifth major surface 160 and sixth major surface 162 .
- the outer perimeter of slide plate 148 can include flats 184 A and 184 B that can engage with corresponding fiat surfaces of recess 180 to prevent rotation.
- Socket 178 can be sized and configured to mate with neck 98 A or neck 98 B of humeral adapter 28 A or humeral adapter 28 B, respectively, of FIG. 4 .
- Socket 178 can be typically round in shape and can form a wall to receive the desired neck.
- the wall can be flat and straight such that socket 178 is cylindrical.
- the wall can be flat and angled such that socket 178 is conical in shape.
- the wall can be arcuate such that socket 178 is hemi-spherical in shape.
- the wall can have a compound shape with two surfaces, flat or curved, angled with respect to each other.
- Socket 178 provides a frictional engagement with a neck of a femoral component, such as necks 98 A and 98 B of adapters 28 A and 28 B, respectively.
- Socket 142 can be larger than socket 178 so as to form a well within trialing head 134 . As such, a neck extending through socket 178 and into socket 142 can be moved around within the area of trialing head 134 as bushing 150 slides against slide plate 148 .
- trialing head 134 can be made from a metallic material
- slide plate 148 can be made of a metallic material
- bushing 150 can be made of a polymer material.
- other materials and combinations of materials can be used.
- humeral stem 30 With humeral stem 30 ( FIG. 4 ) inserted into a humerus bone, neck 98 A or neck 98 B from humeral adapter 28 A or humeral adapter 28 B can be inserted into socket 178 in bushing 150 .
- Access opening 144 can align with fastener hole 164 such that fastener 152 can be inserted through trialing head 134 into bushing 150 .
- Fastener 152 can include head portion 186 A and shaft portion 186 B.
- fastener 152 can be configured to be captive within humeral head trialing device 130 so that fastener 152 cannot be removed.
- fastener 152 can include a fixed washer attached to fastener 152 after assembly (e.g., via welding) to prevent shaft portion 186 B from being fully retracted from fastener hole 164
- access opening 144 can include a flange that permits fastener 152 to be inserted into trialing head 134 but that engage head portion 186 A to prevent shaft portion 186 B from being fully retracted from fastener hole 164
- Fastener 152 can remain in a loosened position with head portion 186 A resting on or near ledge 177 such that slide plate 148 is not pulled into engagement with surface 182 via engagement between threading on fastener 152 and fastener hole 164 .
- trialing head 134 With fastener 152 in a loosened position, the position of trialing head 134 relative to the humeral bone can be adjusted.
- bushing 150 can slide against slide plate 148 and trialing head 134 can be rotated such that bushing 150 rotates around neck 98 A or neck 98 B.
- Trialing head 134 can be translated by translating rails 176 A and 176 B within slots 166 A and 166 B of slide plate 148 , respectively.
- Rails 176 A and 176 B and slots 166 A and 166 B can be configured so that slide plate 148 and bushing 150 are co-planar, or substantially co-planar, so that bushing 150 is, for example, nested within slide plate 148 .
- trialing head 134 can be located in any desired positioned relative the humeral bone by the surgeon, thereby changing the offset of humeral head trialing device 130 .
- fastener 152 can be changed from the loosened position to a tightened position to lock the configuration of offset slide device 132 .
- bushing 150 can be crushed or partially crushed between slide plate 148 and trialing head 134 .
- a driver instrument e.g., a screw driver or driver instrument 118 of FIG. 8
- bushing 150 can be sandwiched between portions of slide plate 148 and trialing head 134 to immobilize bushing 150 .
- bushing 150 can be configured to have a surface, edge or ledge that can be pushed into an engaging surface of trialing head 134 as fastener 152 draws slide plate 148 closer to trialing head 134 .
- flanges 174 can be configured to have lengths that allow end surfaces 168 of flanges 174 to be pushed into end wall 143 of socket 142 as fastener 152 is tightened. Engagement between end surfaces 168 and end wall 143 can push flanges 174 toward each other to collapse flanges down around a neck 98 A or 98 B of an adapter 28 A or 28 B to tighten the fit.
- Flanges 174 or similar features, that can collapse around a stem component neck when tightened by a fastener can be incorporated into any of the humeral head trialing devices described herein having a bore that receives the stem component neck.
- Shaft portion 186 B can be advanced into fastener hole 164 to move slide plate 148 toward surface 182 and immobilize bushing 150 , or can be retreated from fastener hole 164 to retreat slide plate 148 from surface 182 and free bushing 150 for translation.
- frictional engagement between socket 178 and the neck of the humeral stem component can hold the humeral stem component in engagement with offset slide device 132 in an unlocked configuration
- frictional engagement of socket 178 in combination with inward pressure from collapsing of flanges 174 can hold the humeral stem component in engagement with offset slide device 132 in a locked configuration.
- FIG. 13 is a perspective view of humeral head trialing device 130 of FIGS. 10-12B mounted on humerus bone H and drive instrument 188 positioned to engage rotational features 146 A and 146 B of trialing head 134 .
- Drive instrument 188 can engage trialing head 134 to facilitate rotation and translation of trialing head 134 .
- drive instrument 188 can include tabs 190 A and 190 B that are sized and shaped to fit into rotational features 146 A and 146 B, respectively.
- rotational features 146 A and 146 B can comprise round holes and tabs 190 A and 190 B can comprise round posts.
- Drive instrument 188 can also include surface 192 that can be shaped or contoured to engage trialing head 134 and to permit clearance to allow tabs 190 A and 190 B to enter rotational features 146 A and 146 B.
- trialing head 134 When trialing head 134 is first connected to humerus H, trialing head 134 is free to move around. In the orientation shown in FIG. 13 , the position of access opening 144 can be changed in the up-and-down direction (relative to the orientation of FIG. 13 ). Trialing head 134 can be rotated about an axis of the neck inserted into humeral head trialing device 130 to allow the position of access opening 144 to be changed in the side-to-side direction (relative to the orientation of FIG. 13 ). Once the desired position of trialing head 134 is determined by a surgeon, driver instrument 118 of FIG. 8 can be inserted into access opening 144 to move fastener 152 into a tightened position.
- the relative position between trialing head 134 and humerus H can be marked, identified or shown using indicator 194 .
- indicator 194 For example, a surgeon can use a tool or marker to indicate on humerus H where indicator 194 should be located in the final position for correlating a position of a humeral head implant.
- Indicator 194 can be located on trialing head 134 and can be located in the same place on different trialing heads 134 , in the direction where bushing 150 is translated a maximum distance relative to slide plate 148 . This allows the surgeon to mark humerus H with a surgical marker or electrocautery (e.g., a Bovie) at the tip of the arrow comprising indicator 194 .
- the mark provided on humerus H at indicator 194 can act as a patient-specific landmark that allows the surgeon to position the final prosthetic implant so that the maximum offset of the final prosthetic implant is aligned with the mark on humerus H.
- Humeral head trialing device 130 can be removed from humeral adapter 28 and the relative position between bushing 150 and slide plate 148 can be shown, identified, marked, and/or recorded.
- indicators 156 A and 156 B can align with size indicia 158 A and 158 B to indicate a size of a humeral head to implant in the specific patient.
- Indicators 156 A and 156 B can be any feature or marking that provides a constant frame of reference on slide plate 148 and that overlaps or otherwise interacts with indicia 158 A and 158 B.
- Each of the hash marks provided by indicia 158 A and 158 B can correspond to an offset size of a prosthetic humeral head.
- size A can correspond to a zero offset where the center of socket 178 aligns with the center of curved articulating surface 136 , with sizes B-F indicating progressively larger offsets.
- Indicators 156 A and 156 B can include markers that indicate to a user where to look to take the size reading. In the example shown, indicators 156 A and 156 B comprise arrows pointing to indicia 158 A or 158 B.
- FIG. 14A is an exploded view of an alternative embodiment of the humeral head trialing device 130 of FIGS. 10-12B where bushing 150 includes slots 195 A and 195 B for receiving rails 196 A and 196 B of slide plate 148 .
- Humeral head trialing device 130 of FIG. 14A is substantially the same as that of FIGS. 12A and 12B except that hushing 150 includes slots 195 A and 195 B instead of rails 176 A and 176 B, and slide plate 148 includes rails 196 A and 196 B instead of slots 166 A and 166 B.
- fastener 152 can be configured to not pass through bushing 150 .
- fastener 152 can be tightened to draw slide plate 148 toward trialing head 134 to sandwich bushing 150 between surfaces of trialing head 134 and slide plate 148 to lock the relative positions of bushing 150 and slide plate 148 .
- Rails 196 A and 196 B can have wider portions 197 A and 197 B and narrower portions 198 A and 198 B, respectively, which can facilitate coupling of bushing 150 to rails 196 A and 196 B.
- Slots 195 A and 195 B can include wider portions 199 A and 199 B and narrower portions 199 C and 199 D, respectively, which can facilitate coupling to bushing 150 .
- bushing 150 can be angled with respect to slide plate 148 to allow wider portions 197 A and 197 B to be inserted into slots 195 A and 195 B, respectively. Narrower portions 199 C and 199 D can then be slid underneath rails 196 A and 196 B to position bushing 150 against slide plate 148 .
- Wider portions 199 A and 199 B can then rest on wider portions 197 A and 197 B and narrower portions 198 A and 198 B of rails 196 A and 196 B, while narrower portions 199 C and 199 D are disposed underneath wider portions 197 A and 197 B.
- Rails 196 A and 196 B are, however, longer than slots 195 A and 195 B so that bushing 150 can translate within aperture 167 .
- Rails 196 A and 196 B and slots 195 A and 195 B can be configured so that slide plate 148 and bushing 150 are co-planar, or substantially co-planar, so that bushing 150 is, for example, nested within slide plate 148 .
- FIG. 14B is a perspective view of trialing head 134 used in humeral head trialing device 130 of FIG. 14A showing socket 142 and recess 180 for receiving bushing 150 and slide plate 148 .
- Recess 180 is configured to mate with the edge of slide plate 148 so that offset slide device 132 can be tightly fit into recess 180 .
- Flats 184 A and 184 B of recess 180 along with corresponding flats on slide plate 148 prevent offset slide device 132 from rotating within recess 180 .
- sixth major surface 162 can abut surface 182 of trialing head 134 .
- access opening 144 can align with fastener hole 164 .
- Fastener 152 can be inserted into access opening 144 , passed through ledge 177 in trialing head 134 and threaded into fastener hole 164 .
- FIG. 14C is a cross-sectional view of humeral head trialing device 130 of FIG. 14A showing interacting forces generated by fastener 152 .
- Fastener 152 is threaded down into fastener hole 164 as shown by arrow A 1 to bring head portion 186 A into contact with ledge 177 at callout C 1 .
- Additional threading or tightening of shaft portion 186 B causes slide plate 148 to move upward, as shown by arrow A 2 .
- Slide plate 148 is then pushed upward against surface 182 as shown in callout C 2 .
- Sixth major surface 162 can include platform 193 that is elevated from a remaining portion of sixth major surface 162 .
- Platform 193 can act as a lever mechanism when fastener 152 draws slide plate 148 toward surface 182 .
- slide plate 148 will rotate at platform 193 as fastener hole 164 is drawn closer to surface 182 , which can cause the end of slide plate 148 opposite of platform 193 to rotate toward surface 182 , as shown by arrow A 3 .
- the lever action provided by platform 193 can improve the friction force that clamps down against bushing 150 by causing both ends of slide plate 148 to be drawn in tight to surface 182 .
- the lever action additionally can prevent slide plate 148 from rocking or rotating about bushing 150 , which can interfere with alignment between humeral head trialing device 130 and a humeral stem component.
- bushing 150 can include cut-outs 175 to form flanges 174 that permit bushing 150 to flex and receive neck 98 A or 98 B.
- FIG. 15A is a top perspective view of humeral head trialing device 200 for use with humeral head prosthetic device system 10 of FIG. 4 .
- FIG. 15B is a bottom perspective view of humeral head trialing device 200 of FIG. 15A showing offset slide device 202 within trialing head 204 .
- Humeral head trialing device 200 is similar to other humeral head trialing device described herein and can be used with features described with reference to the other embodiments.
- Humeral head trialing device 200 can include fastener 206 for locking offset slide device 202 .
- Trialing head 204 can comprise curved articulating surface 208 , edge perimeter 210 having scallops 212 , interior surface 214 , socket 216 and access opening 218 .
- Offset slide device 202 can include trial offset plate 220 and trial offset slide 222 .
- Trial offset plate 220 and trial offset slide 222 can be coupled together using fastener 206 .
- Trial offset plate 220 and trial offset slide 222 can operate in a similar fashion as mounting plate 40 and adapter coupling plate 42 of humeral head trialing device 36 , respectively.
- trial offset slide 222 can include rails that are captured within channels of trial offset plate 220 .
- Trial offset plate 220 is inserted into socket 216 of trialing head 204 and can be held in place by frictional interaction between trial offset plate 220 and trialing head 204 at socket 216 .
- Fastener 206 can be extended into access opening 218 to engage fastener bore 224 in trial offset plate 220 to prevent trial offset plate 220 from separating from trialing head 204 .
- Trial offset slide 222 can slide between trialing head 204 and trial offset plate 220 such that indicators 226 A and 226 B can align with size indicia 228 A and 228 B on trial offset plate 220 .
- Fastener 206 can be adjusted to immobilize trial offset slide 222 relative to trial offset plate 222 .
- FIG. 16 is a top perspective view of a first embodiment of offset slide device 220 including a trial offset plate 220 , trial offset slide 222 and fastener 206 .
- Trial offset plate 220 can include seventh major surface 230 , eighth major surface 232 , flats 234 A and 234 B, aperture 236 , slots 238 A and 238 B ( FIG. 20A ), cutouts 240 A and 240 B, post 242 and fastener bore 224 ( FIG. 15 ).
- Trial offset slide 222 can include ninth major surface 244 , tenth major surface 246 , flats 248 A and 248 B, coupling bore 250 , rails 252 A and 252 B, cutouts 254 A and 254 B and notch 256 .
- Trial offset plate 220 can be configured to be positioned within socket 216 of trialing head 204 ( FIG. 15 ). Flats 234 A and 234 B can prevent trial offset plate 220 from rotating within socket 216 .
- Aperture 236 can be configured to receive trial offset slide 222 and can comprise a U-shaped cut-out in trial offset plate 220 .
- Aperture 236 can be partially bounded by crosspiece 258 on which post 242 can be disposed.
- Aperture 236 can include slots 238 A and 238 B and cutouts 240 A and 240 B that can mate with trial offset slide 222 .
- Rails 252 A and 252 B of trial offset slide 222 can be inserted into slots 238 A and 238 B, respectively.
- Rails 252 A and 252 B and slots 238 A and 238 B can be configured to hold trial offset slide 222 co-planar, or substantially co-planar, with trial offset plate 220 such that trial offset slide 222 can be nested within trial offset plate 220 .
- Rails 252 A and 252 B and slots 238 A and 238 B can be shaped and configured to allow cutouts 240 A and 240 B to mate with cutouts 254 A and 254 B, respectively, to, for example, limit movement of trial offset slide 222 .
- Trial offset slide 222 can be moved away from the centered position of FIG. 16 to a plurality of offset positions by moving trial offset slide 222 to the left (with respect to the orientation of FIG. 16 ).
- a partially offset position is shown in FIG. 20C .
- aperture 236 and cutouts 240 A and 240 B are shaped to engage with end 264 and cutouts 254 A and 254 B, respectively, while rails 252 A and 252 B slide in slots 238 A and 238 B, respectively. With end 264 directly engaging aperture 236 , trial offset slide 222 can be positioned away from post 242 .
- trial offset slide 222 can remain supported by crosspiece 258 such that head 260 and flange 262 of fastener 206 can push trial offset slide 222 against crosspiece 258 to immobilize trial offset slide 222 (See FIG. 20C ).
- trial offset slide 222 can be positioned to align one of indicators 226 A and 226 B with one of size indicia 228 A and 228 B.
- Indicators 226 A and 226 B are positioned so that only one size indicia will be indicated for the offset of trial offset slide 222 .
- one of sizes A-F can be selected by indicators 226 A and 226 B by pointing to size indicia 228 A and 228 B, for example.
- FIG. 17 is a top perspective view of a second embodiment of offset slide device 202 including trial offset plate 220 and trial offset slide 222 with bushing 266 .
- Trial offset plate 220 of FIG. 17 can function in the same manner as that of FIG. 16 except that coupling bore 250 is provided with bushing 266 .
- Bushing 266 can function as a liner to coupling bore 250 that facilitates engagement with an adapter neck, such as neck 98 A or neck 98 B of humeral adapter 28 A and humeral adapter 28 B, respectively.
- Trial offset slide 222 can be made of a rigid metallic material and bushing 266 can be comprised of a resilient material, such as a plastic or polymer.
- Bushing 266 can soften the engagement with the humeral adapter, prevent damage to the humeral adapter and facilitate affixation to the humeral adapter.
- Bushing 266 can include axial portion 268 that extends across coupling bore 250 and one or more flange portions 270 that can extend radially across ninth and tenth major surfaces 244 and 246 , respectively, to inhibit bushing 266 from separating from coupling bore 250 .
- Bushing 266 can be configured as a separate piece that can be installed into and removed from trial offset slide 222 .
- a bushing 266 having a different sized axial portion 268 e.g., a different diameter socket
- other bushing components can be attached to trial offset slide 222 , such as those including a projection feature (e.g., a projection feature similar to projection feature 272 of FIG. 18 ) instead of a socket can be attached to trial offset slide 222 .
- FIG. 18 is a bottom perspective view of a third embodiment of offset slide device 202 including trial offset plate 220 and trial offset slide 222 with projection feature 272 .
- Trial offset plate 220 of FIG. 18 can function in the same manner as that of FIG. 16 except that coupling bore 250 is provided with projection feature 272 .
- Projection feature 272 can include cylindrical portion 272 A and end wall 272 B.
- Projection feature 272 can be solid or hollow.
- Projection feature 272 can function to interact with a female socket on a humeral adapter or humeral stem, such as humeral adapter 28 A, humeral adapter 28 B, or humeral stem 30 .
- projection feature 272 can be integral with trial offset slide 222 and coupling bore 250 such that cylindrical portion 272 A extends from tenth major surface 246 .
- projection feature 272 can be a separate component from trial offset slide 222 that can be mated with coupling bore 250 .
- projection feature 272 can be inserted into coupling bore 250 from ninth major surface 244 so that cylindrical portion 272 A can extend through trial offset slide 222 and beyond tenth major surface 246 .
- projection feature 272 can be threaded into ninth major surface 244 at or adjacent coupling bore 250 .
- Projection feature 272 can be included in any of the humeral head trialing devices described herein.
- adapter coupling hole 68 of FIGS. 3A and 3B can include a cylindrical portion projecting from adapter coupling plate 42 and an end wall closing off the cylindrical portion.
- socket 178 of FIG. 11 can include a projection feature similar to projection feature 272 .
- FIG. 19 is a bottom view of trialing head 204 of FIGS. 15A and 15B showing trial mechanism well 274 , scallops 212 , anti-rotation features 276 A and 276 B, and retention features 280 A and 280 B.
- Edge perimeter region 210 can include scallops 212 that can act as gripping features to facilitate rotation of trialing head 204 by a surgeon.
- scallops 212 can increase friction between trialing head 204 and a hand of the surgeon to allow trialing head 204 to be rotated on the neck of the adapter to which it is mounted (see FIG. 20D ).
- edge perimeter region 210 and trialing head 204 can include other gripping features with different shapes.
- edge perimeter 210 can be provided with scoring, crenellations, knurling and the like.
- trialing head 204 can be provided with other rotational features that facilitate gripping and rotating of trialing head 204 by a surgeon.
- trialing head 204 can include various sockets (e.g., sockets 146 A and 146 B of FIG. 10 ) to facilitate coupling with a tool (e.g., instrument 188 of FIG. 13 ).
- a tool e.g., instrument 188 of FIG. 13
- trialing head 204 could include a hex socket 213 at its center to mate with a driver instrument, such as a hex key, an Allen wrench or the like.
- Trial mechanism well 274 can comprise a thinned portion of trialing head 204 , e.g., a portion of trial mechanism well 274 that has a thickness that is smaller than other portions of trial mechanism well 274 , to provides space within trialing head 204 to accommodate offset slide device 202 .
- Trial mechanism well 274 can be smaller than socket 216 to allow trial offset plate 220 to be tightly fit with trialing head 204 .
- Trial mechanism well 274 can be located opposite coupling bore 250 when assembled with offset slide device 202 and can be wide enough to allow coupling bore 250 to move from the centered position of FIG. 20B to various offset positions, such as shown in FIG. 20C , with a humeral adapter neck inserted therein.
- Trial mechanism well 274 can be deep enough to accommodate the neck of the adapter inserted into coupling bore 250 , as well as any projection feature 272 that can be extended from coupling bore 250 .
- Trial mechanism well 274 can include pocket 278 that can be included to provide space for head 260 and flange 262 of fastener 206 . Pocket 278 need not be contiguous with trial mechanism well 274 . Pocket 278 can thus be provided at the location of access opening 218 , and pocket 278 can surround access opening 218 .
- Inner surface 281 of trialing head 204 can include retention features 280 A and 280 B.
- Retention features 280 A and 280 B can be configured to assist with holding trial offset plate 220 within socket 216 in addition to or alternatively to any frictional fit or press fit forces provided by the interaction of trial offset plate 220 and pocket 216 .
- pocket 216 can be shaped to have approximately the same outer perimeter shape as trial offset plate 220 to hold trial offset plate 220 snuggly in place.
- trialing head 204 can be provided with other features to hold trial offset plate 220 in place.
- Retention features 280 A and 280 B can comprise magnets that are embedded into inner surface 281 of trialing head 204 .
- the magnets of retention features 280 A and 280 B can hold onto trial offset plate 220 .
- Retention features 280 A and 280 B can be press fit into sockets within inner surface 281 and can be additionally or alternatively held in place with adhesive.
- retention features 280 A and 280 B can comprise adhesive pads deposited onto inner surface 281 to hold onto trial offset plate 220 by adhesive forces.
- FIG. 20A is a partially exploded view of humeral head trialing device 200 of FIGS. 15A and 15B showing offset slide device 202 of FIGS. 15 and 16 positioned relative to trial mechanism well 274 of trialing head 204 of FIGS. 15 and 19 .
- trial offset plate 220 can be aligned to be generally parallel to interior surface 214 of trialing head 204 .
- Trial offset plate 220 can also be aligned with socket 216 such that the shape of trial offset plate 220 aligns with the shape of socket 216 .
- Trial offset plate 220 can then be inserted into socket 216 with trial offset slide 222 already coupled to trial offset plate 220 .
- retention features 280 A and 280 B can couple to trial offset plate 220 to prevent trial offset plate 220 from dislodging from socket 216 .
- FIG. 20B is a perspective view of humeral head trialing device 200 of FIGS. 15A and 15B showing offset slide device 202 of FIG. 20A inserted into trial mechanism well 274 .
- trial offset slide 222 can be positioned partially behind trial offset plate 220 so that trial offset slide 222 cannot be separated from humeral head trialing device 200 when assembled.
- rails 252 A and 252 B can be retained within slots 238 A and 238 B ( FIG. 16 ), respectively, to contain trial offset slide 222 .
- Trial offset slide 222 is shown in the centered position where indicator 226 A aligns with one of size indicia 228 A that corresponds to a centered position of trialing head 204 , which can comprise “size A” as discussed above.
- Fastener 206 can be set to a loosened position to permit trial offset slide 222 to slide within trial offset plate 220 .
- FIG. 20C is a bottom plan view of humeral head trialing device 200 of FIGS. 15A and 15B showing trial offset slide 222 translated within slots 238 A and 238 B of trial offset plate 220 to expose notch 256 .
- Trial offset slide 222 is translated away from the centered position of FIG. 20B to an offset position where indicator 226 A aligns with one of size indicia 228 A, which can comprise “size E” as discussed above.
- Flange 262 of fastener 206 can extend beyond crosspiece 258 to overlap with portions of trial offset slide 222 at notch 256 .
- trial offset slide 222 can be locked into position relative to trial offset plate 220 by tightening of fastener 206 .
- Fastener 206 can be positioned on post 242 and flange 262 can be sized to engage trial offset slide 222 even when end 264 is positioned to abut aperture 236 . Fastener 206 can remain in a loosened position to permit trial offset slide 222 to slide within trial offset plate 220 so that trialing head 204 can be adjusted relative to a humeral stem implant.
- FIG. 20D is a perspective view of humeral head trialing device 200 of FIGS. 15A and 15B showing offset slide device 202 aligned with neck 282 of humeral stem 284 .
- Neck 282 can be inserted into coupling bore 250 in order to seat humeral head trialing device 200 onto humeral stem 284 .
- Humeral stem 284 can include flange 286 that can be configured to be positioned proximate a resected humeral bone surface.
- Trialing head 204 can be positioned relative to flange 286 by rotating coupling bore 250 about neck 282 and translating trial offset slide 222 relative to trial offset plate 220 .
- FIG. 20E is a front plan view of humeral head trialing device 200 of FIGS. 15A and 15B attached to humeral stem 284 to illustrate rotational and translational movement capabilities of trialing head 204 .
- Edge perimeter 210 can approximately match the circumference of flange 286 .
- edge perimeter 210 can approximately overlap with the edge of flange 286 .
- the centers of trialing head 204 , coupling bore 250 and flange 286 can all be aligned so that trialing head 204 can completely cover flange 286 .
- trialing head 204 can be rotated in clockwise and counterclockwise directions, as shown by arrows A 4 and A 5 , and can be translated in two directions along a midline of trialing head 204 through which fastener 206 passes, as shown by arrow A 6 , to reposition the center of trialing head 204 relative to flange 286 , which can partially uncover portions of flange 286 .
- FIG. 20F is a front plan view of humeral head trialing device 200 of FIGS. 15A and 15B showing trialing head 204 rotated and translated from the position of FIG. 20E .
- Trialing head 204 is shown rotated approximately ninety degrees from the position of FIG. 20E and then translated down and to the left (relative to the orientation of FIGS. 20E and 20F ) to expose a tight-hand portion of flange 286 .
- the combination of rotation provided by coupling bore 250 and the translation provided by trial offset slide 222 can allow the center of trialing head 204 to be positioned anywhere within an offset radius of the center of flange 286 .
- the offset radius can be determined by the stroke length of trial offset slide 222 from the centered position the position of FIG. 20B ) to the maximum offset position where end 264 abuts aperture 236 (See FIG. 20C ).
- Example 1 can include or use subject matter such as a system for aligning a prosthetic head component with a prosthetic stem
- the system can comprise: a mounting plate that can comprise: a first major surface; a second major surface opposing the first major surface; an adapter accommodation hole extending through from the first major surface to the second major surface; and sizing indicia located on the second major surface; a first fastener extending from the mounting plate; and an adapter coupling plate slidably engaged with the mounting plate
- the adapter coupling plate can comprise: a third major surface facing in a direction of the first major surface; a fourth major surface opposing the third major surface; an adapter coupling hole extending through from the third major surface to the fourth major surface, the adapter coupling hole surrounded by the adapter accommodation hole; and an indicator located on the fourth major surface to point to various portions of the sizing indicia as the adapter coupling plate slides against the mounting plate at the first slot.
- Example 2 can include, or can optionally be combined with the subject matter of Example 1, to optionally include the prosthetic head component, the prosthetic head component can comprise: an outer curved surface for approximating an anatomic articulation surface of an anatomic head; and an inner surface having a cavity that accepts the first major surface of the mounting plate.
- Example 3 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 or 2 to optionally include a fastener that can extend into the prosthetic head component so as to be accessible from the outer curved surface.
- Example 4 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 3 to optionally include a prosthetic head component that can include a first access hole in the outer curved surface aligned with the first fastener.
- Example 5 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 4 to optionally include a stem adapter that can comprise: a body for engaging a socket of the prosthetic stem; and a neck extending from the body frictionally engaged with the adapter coupling hole and passing freely into the adapter accommodation hole.
- a stem adapter that can comprise: a body for engaging a socket of the prosthetic stem; and a neck extending from the body frictionally engaged with the adapter coupling hole and passing freely into the adapter accommodation hole.
- Example 6 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 5 to optionally include a prosthetic stem, wherein the prosthetic stein can comprise a humeral stem and the prosthetic head component comprises a humeral head.
- Example 7 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 6 to optionally include a magnet located in the cavity to engage the first major surface of the mounting plate.
- Example 8 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 7 to optionally include a mounting plate that is friction fit into the cavity of the prosthetic head component.
- Example 9 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 8 to optionally include a first deformable sleeve to engage the first fastener.
- Example 10 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 9 to optionally include an outer curved surface of the prosthetic head component that includes a rotational feature.
- Example 11 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 10 to optionally include a rotational feature that comprises scallops disposed around a periphery of the outer curved surface.
- Example 12 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 11 to optionally include a rotational feature that comprises a socket disposed in the outer curved surface.
- Example 13 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 12 to optionally include an inner surface of the prosthetic head component that is textured to increase frictional engagement with bone.
- Example 14 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 13 to optionally include a first fastener that is threaded into the mounting plate and passes through the adapter coupling plate.
- Example 15 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 14 to optionally include an adapter coupling plate that can includes a first slot extending through from the third major surface to the fourth major surface and through which the first fastener extends.
- Example 16 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 15 to optionally include a first fastener that can include a stop to prevent the adapter coupling plate from separating from the first fastener.
- Example 17 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 16 to optionally include a second fastener extending from the mounting plate, wherein the first and second fasteners are threaded into the mounting plate and the adapter coupling plate is slidably along the first and second fasteners.
- Example 18 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 17 to optionally include each of the first and second slide posts comprising: a shaft threadably engaged with the mounting plate; an engagement head located proximate the first major surface of the mounting plate; and a stop located proximate the fourth major surface of the adapter coupling plate.
- Example 19 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 18 to optionally include a mounting plate that is slidably engaged with the adapter coupling plate via a tongue and groove system.
- Example 20 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 19 to optionally include a tongue and groove system comprising: a pair of rails extending from the adapter coupling plate; and a pair of slots extending in the mounting plate.
- a tongue and groove system comprising: a pair of rails extending from the adapter coupling plate; and a pair of slots extending in the mounting plate.
- Example 21 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 20 to optionally include a tongue and groove system comprising: a pair of rails extending from the mounting plate; and a pair of slots extending in the adapter coupling plate.
- Example 22 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 21 to optionally include a third major surface of the adapter coupling plate that is spaced apart from the first major surface of the mounting plate.
- Example 23 can include or use subject matter such as a system for aligning a prosthetic head component with a prosthetic stem, the system can comprise: a mounting plate; a slide post extending through the mounting plate in an adjustable manner; a prosthetic head component stationarily coupled to the mounting plate, the prosthetic head component having an access hole aligned with the slide post; and an adapter coupling plate slideably engaged with the mounting plate via the slide post; wherein the slide post can be adjusted from an exterior of the prosthetic head component through the access hole to immobilize the adapter coupling plate relative to the mounting plate.
- Example 24 can include, or can optionally be combined with the subject matter of Example 23, to optionally include a set of size indicators located on the mounting plate; and a pointer located on the adapter coupling plate; wherein the pointer points to different size indicators as the adapter coupling plate slides against the mounting plate.
- Example 25 can include, or can optionally be combined with the subject matter of one or any combination of Examples 23 or 24 to optionally include a slide post that can be adjusted to lock a position of the adapter coupling plate relative to the mounting plate.
- Example 26 can include, or can optionally be combined with the subject matter of one or any combination of Examples 23 through 25 to optionally include a slide post that is threaded into the mounting plate, the slide post extending through a slot in the adapter coupling plate; a set of size indicators that comprise hash marks located on a surface of the mounting plate facing away from the prosthetic head; and a pointer that can comprise a portion of the adapter coupling plate that can align with each of the hash marks depending on a position of the adapter coupling plate relative to the mounting plate.
- Example 27 can include or use subject matter such as a system for aligning a prosthetic head component with a prosthetic stem, the system can comprise: a mounting plate; a fastener extending from the mounting plate in an adjustable manner; a prosthetic head component stationarily coupled to the mounting plate, the prosthetic head component having an access hole aligned with the fastener; an adapter coupling plate; and a tongue and groove system slideably connecting the mounting plate and the adapter coupling plate; wherein the fastener can be adjusted from an exterior of the prosthetic head component through the access hole to immobilize the adapter coupling plate relative to the mounting plate.
- a system for aligning a prosthetic head component with a prosthetic stem the system can comprise: a mounting plate; a fastener extending from the mounting plate in an adjustable manner; a prosthetic head component stationarily coupled to the mounting plate, the prosthetic head component having an access hole aligned with the fastener; an adapter coupling plate; and a tongue and groove system slideably connecting the mounting plate and
- Example 28 can include, or can optionally be combined with the subject matter of Example 27, to optionally include a set of size indicators located on the mounting plate; and a pointer located on the adapter coupling plate; wherein the pointer points to different size indicators as the adapter coupling plate slides against the mounting plate.
- Example 29 can include, or can optionally be combined with the subject matter of one or any combination of Examples 27 or 28 to optionally include a fastener can be adjusted to bring the mounting plate closer to the prosthetic head component to squeeze the adapter coupling plate between the mounting plate and the prosthetic head component.
- Example 30 can include, or can optionally be combined with the subject matter of one or any combination of Examples 27 through 29 to optionally include a collar extending from the adapter coupling plate, the collar including flanges to receive a neck of a stem adapter, wherein the flanges have a length that configures the flanges to be pushed into the prosthetic head component when the fastener is adjusted to bring the mounting plate closer to the prosthetic head component.
- Example 31 can include, or can optionally be combined with the subject matter of one or any combination of Examples 27 through 30 to optionally include an adapter coupling plate and a mounting plate that are co-planar; and an adapter coupling plate that is thicker than the mounting plate.
- Example 32 can include or use subject matter such as a method for aligning a prosthetic head component with a prosthetic stem, the method can comprise: attaching a mounting plate of a trialing device to a prosthetic head component, the trialing device further including an adapter coupling plate; inserting a neck of a prosthetic stem into the adapter coupling plate; sliding the mounting plate of the trialing device relative to the adapter coupling plate to a adjust a position of the prosthetic head component relative to the neck of the prosthetic stem; and from outside of the prosthetic head, adjusting a fastener connected to the mounting plate to immobilize a position of the adapter coupling plate to lock the position.
- Example 33 can include, or can optionally be combined with the subject matter of Example 32, to optionally include sliding the adapter coupling plate against the fastener.
- Example 34 can include, or can optionally be combined with the subject matter of one or any combination of Examples 32 or 33 to optionally include sliding slots of the adapter coupling plate along rails of the mounting plate.
- Example 35 can include, or can optionally be combined with the subject matter of one or any combination of Examples 32 through 34 to optionally include inserting an instrument through the prosthetic head component to adjust the fastener and lock the position.
- Example 36 can include, or can optionally be combined with the subject matter of one or any combination of Examples 32 through 35 to optionally include removing the trialing device from the neck; and reading a prosthetic size indication from the trialing device after adjusting the post and locking the position.
- Example 37 can include, or can optionally be combined with the subject matter of one or any combination of Examples 32 through 36 to optionally include implanting the prosthetic stem component into a bone before inserting the neck of the prosthetic stem into the adapter coupling plate.
- the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.”
- the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated.
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Abstract
Description
- This application is a divisional of U.S. patent application Ser. No. 15/846,624, filed on Dec. 19, 2017, which claims the benefit of priority to U.S. Provisional Application Ser. No. 62/437,192, filed on Dec. 21, 2016, each of which is incorporated herein by reference in its entirety.
- This document pertains generally, but not by way of limitation, to systems and methods for planning and performing arthroplasty procedures. More particularly, this disclosure relates to, but not by way of limitation, intra-operative planning techniques for selecting the size of a prosthetic device component for a patient into which the prosthetic device component will be implanted.
- A shoulder joint comprises the juncture of the scapula, the clavicle and the humerus. The head of the humerus fits into a shallow socket of the scapula called the glenoid fossa to form a mobile joint. When the joint is articulated, the humeral head moves in the glenoid fossa to provide a wide range of motion. The shoulder joint may suffer from various maladies including rheumatoid arthritis, osteoarthritis, rotator cuff arthropathy, avascular necrosis, bone fracture or failure of previous joint implants. If severe joint damage occurs and no other means of treatment is found to be effective, then shoulder reconstruction may be necessary.
- A shoulder joint prosthesis generally includes the replacement of the ball (glenosphere) of the humerus and, optionally, the socket (glenoid) of the shoulder blade with specially designed artificial components. The bio-kinematics, and thus the range of motion in the shoulder vary greatly among prospective patients for reconstruction shoulder surgery. The humeral component typically can have a metal shaft or stem with a body portion that can be embedded in the resected humerus and a generally hemispherical head portion supported on the stem. The head portion can slidingly engage a glenoid implant on the glenoid fossa. During reconstructive surgery, the components of the prosthesis can be matched with the bio-kinematics of the patient in an effort to maintain the natural range of motion of a healthy shoulder joint. Thus, a shoulder prosthesis design can be readily adaptable to a wide range of bio-kinematics for prospective patients.
- In this regard, shoulder prostheses are generally available as either unitary structures or modular components. With unitary shoulder prosthesis, a large inventory of differently sized prostheses must sometimes be maintained to accommodate the different bone sizes and joint configurations of the prospective patients. With such unitary shoulder prosthesis, the patient can typically be evaluated by X-ray to determine approximate sizes of prostheses needed for reconstruction. A number of differently sized prostheses can be selected as possible candidates based upon this preliminary evaluation. Final selection of the appropriately sized prosthesis can be made during the surgery. With unitary shoulder prosthesis, each design can represent a compromise that is unable to achieve all of the natural range of motion of a healthy shoulder joint because of the fixed geometric configuration in their design.
- Modular prostheses systems that can reduce the need to maintain large inventories of various sized components are well known in the art. Conventionally, a humeral prosthesis can include two components: a humeral stem component and a spherical head releasably coupled to the stem. Alternatively, a three component design is known in which the stem and spherical head are interconnected with an adapter. In either of the two-piece or three-piece designs, a radial offset or angulator inclination of the head relative to the stem can be provided in individual components. Different radial offsets or angular inclinations are achieved through the use of different adapters or heads. In this regard, conventional modular shoulder prosthesis kits can include multiple redundant components such as adapters and heads to achieve a range of prosthetic options.
- While providing an advantage over the unitary design in reducing the number of components needed, a rather large inventory of head components and/or adapter components must sometimes be maintained to provide the desired range of geometric configurations with the conventional modular shoulder prostheses. These components can be readily adaptable to provide a range of geometric configurations, i.e. radial offsets of angular inclination while minimizing the number of components required.
- Examples of humeral head trialing devices are described in U.S. Pat. No. 8,647,387 to Winslow, U.S. Pat. No. 7,431,736 to Maroney et al., U.S. Pat. No. 6,736,852 to Callaway et al., U.S. Pat. No. 6,673,114 to Hartdegen et al., and U.S. Pub. No. 2016/0030187 to Sperling et al.
- The present inventors have recognized, among other things, that a problem to be solved relates to the need for surgeons to have to select a proper size and manually adjust the location and orientation of a humeral head and a corresponding humeral head trial, which can typically involve the movement of several components that are intricately attached to each other, in order to select a properly-sized unitary or modular shoulder prosthesis. These components typically can be manually held together in place in order to make the proper reading of the size of the humeral head trial. Thus, the surgeon can be left with needing to make several estimates of the humeral head size while holding the components in place.
- The present subject matter can help provide a solution to various problems associated with the trialing of a humeral head by providing a trialing assembly that can be used to couple humeral stems or humeral adapters with multiple humeral head trials. The trialing assembly can be locked in place without removing the humeral head trial from the anatomy to ensure accurate readings are taken from the assembly and a proper head size is selected. The trialing assembly can be easily assembled and disassembled, cleaned and reused, thereby minimizing the number of components and instruments that must be maintained in inventory.
- In an example, the present subject matter can help provide a solution to this problem, such as by providing a system for aligning a prosthetic head implant with a prosthetic stem that can comprise a mounting plate, a first fastener and an adapter coupling plate. The mounting plate can comprise: a first major surface; a second major surface opposing the first major surface; an adapter accommodation hole extending through from the first major surface to the second major surface; and sizing indicia located on the second major surface. The first fastener can extend from the mounting plate. The adapter coupling plate can be slidably engaged with the mounting plate and can comprise: a third major surface facing in a direction of the first major surface; a fourth major surface opposing the third major surface; an adapter coupling hole extending through from the third major surface to the fourth major surface, the adapter coupling hole surrounded by the adapter accommodation hole; and an indicator located on the fourth major surface to point to various portions of the sizing indicia as the adapter coupling plate slides against the mounting plate at the first slot.
- In another example, a system for aligning a prosthetic head implant with a prosthetic stem can comprise: a mounting plate, a slide post, a prosthetic head and an adapter coupling plate. The slide post can extend through the mounting plate in an adjustable manner. The prosthetic head can be stationarily coupled to the mounting plate and have an access hole aligned with the slide post. The adapter coupling plate can be slideably engaged with the mounting plate via the slide post. The slide post can be adjusted from an exterior of the prosthetic head component through the access hole to immobilize the adapter coupling plate relative to the mounting plate.
- In yet another example, a system for aligning a prosthetic head component with a prosthetic stem can comprise: a mounting plate; a fastener, a prosthetic head, an adapter coupling plate and a tongue and groove system. The fastener can extend from the mounting plate in an adjustable manner. The prosthetic head can be stationarily coupled to the mounting plate and have an access hole aligned with the fastener. The tongue and groove system can slideably connect the mounting plate and the adapter coupling plate. The fastener can be adjusted from an exterior of the prosthetic head component through the access hole to immobilize the adapter coupling plate relative to the mounting plate.
- In still another example, a method for aligning a prosthetic head component with a prosthetic stem can comprise: attaching a mounting plate of a trialing device to a prosthetic head component, the trialing device further including an adapter coupling plate; inserting a neck of a prosthetic stem into the adapter coupling plate; sliding the mounting plate of the trialing device relative to the adapter coupling plate to a adjust a position of the prosthetic head component relative to the neck of the prosthetic stem; and from outside of the prosthetic head, adjusting a fastener connected to the mounting plate to immobilize a position of the adapter coupling plate to lock the position.
- This overview is intended to provide an overview of subject matter of the present patent application. It is not intended to provide an exclusive or exhaustive explanation of the invention. The detailed description is included to provide further information about the present patent application.
-
FIG. 1 is a front perspective view of a total shoulder arthroplasty system in which a humerus bone includes a humeral head prosthetic device system. -
FIG. 2 is a schematic illustration of the humeral head prosthetic device system ofFIG. 1 implanted in a humerus bone and showing a coupling device connecting a prosthetic head with a humeral adapter and a humeral stem. -
FIGS. 3A and 3B are lateral and medial exploded views of a trialing device for use as or selection of the coupling device ofFIG. 2 showing a trialing head, a mounting plate and an adapter coupling plate. -
FIG. 4 is a flow chart of the humeral head prosthetic device system ofFIG. 2 showing a conversion ring for use as the coupling device and connecting the prosthetic head with the humeral adapter and the humeral stem. -
FIG. 5 is a front view of a humeral head template used to initially size a humeral head trial or prosthetic. -
FIG. 6 is a perspective view of the trialing device ofFIGS. 3A and 3B assembled with the trialing head and showing the adapter coupling plate connected to the mounting plate via a pair of slide posts. -
FIG. 7 is a schematic perspective view of the trialing head ofFIG. 6 coupled to a humeral adapter implanted into a humerus bone illustrating multiple degrees of freedom of movement. -
FIG. 8 is a perspective view of an exterior of the trialing head ofFIG. 7 showing a driver instrument adjusting one of the slide posts. -
FIG. 9 is an interior side view of the trialing device ofFIGS. 6-8 after adjustment showing an indicator aligning with sizing indicia. -
FIG. 10 is a perspective view of another embodiment of a humeral head trialing device for use with the humeral head prosthetic device system ofFIG. 4 wherein a slide plate includes slots for receiving rails of a bushing. -
FIG. 11 is a bottom plan view of the humeral head trialing device ofFIG. 10 showing an embodiment of an offset slide device within a trialing head. -
FIG. 12A is a cross-sectional view of the humeral head trialing device ofFIG. 11 taken along a center of the device to show the offset slide device having a trialing head, a slide plate, a bushing and a set screw. -
FIG. 12B is a perspective cross-sectional view of the humeral head trialing device ofFIG. 11 taken offset from a center of the device to show a bushing rail. -
FIG. 13 is a perspective view of the humeral head trialing device ofFIGS. 10-12B mounted on a humerus bone and a drive instrument positioned to engage rotational features of the trialing head. -
FIG. 14A is an exploded view of an alternative embodiment of the humeral head trialing device ofFIGS. 10-12B wherein the bushing includes slots for receiving rails of the slide plate. -
FIG. 14B is a perspective view of a trialing head used in the humeral head trialing device ofFIG. 14A showing a well and a socket for receiving the bushing and slide plate. -
FIG. 14C is a cross-sectional view of the humeral head trialing device ofFIG. 14A showing interacting forces generated by a fastener. -
FIG. 15A is a top perspective view of another embodiment of a humeral head trialing device for use with the humeral head prosthetic device system ofFIG. 4 . -
FIG. 15B is a bottom perspective view of the humeral head trialing device ofFIG. 15A showing another embodiment of an offset slide device within a trialing head. -
FIG. 16 is a top perspective view of a first embodiment of the offset slide device including a trial offset plate, trial offset slide and a locking screw. -
FIG. 17 is a top perspective view of a second embodiment of the offset slide device including a trial offset plate and a trial offset slide with a bushing. -
FIG. 18 is a bottom perspective view of a third embodiment of the offset slide device including a trial offset plate and a trial offset slide with a projection feature. -
FIG. 19 is a bottom view of the trialing head ofFIGS. 15A and 15B showing a trial mechanism well, gripping features, anti-rotation features and retention features. -
FIG. 20A is a partially exploded view of the humeral head trialing device ofFIGS. 15A and 15B showing the offset slide device ofFIGS. 15 and 16 positioned relative to the trial mechanism well of the trialing head ofFIGS. 15 and 19 . -
FIG. 20B is a perspective view of the humeral head trialing device ofFIGS. 15A and 15B showing the offset slide device ofFIG. 20A inserted into the trial mechanism well. -
FIG. 20C is a bottom plan view of the humeral head trialing device ofFIGS. 15A and 15B showing the trial offset slide translated within a groove of the trial offset plate to expose a fastener channel. -
FIG. 20D is a perspective view of the humeral head trialing device ofFIGS. 15A and 15B showing the offset slide device aligned with a neck of a humeral stem. -
FIG. 20E is a front plan view of the humeral head trialing device ofFIGS. 15A and 15B attached to the humeral stem to illustrate rotational and translational movement capabilities of the trialing head. -
FIG. 20F is a front plan view of the humeral head trialing device ofFIGS. 15A and 15B showing the trialing head rotated and translated from the position ofFIG. 20E . -
FIG. 1 is a front perspective view of totalshoulder arthroplasty system 10 comprising implanted prosthetic glenoid 12 and implanted humeral headprosthetic device system 14. Prosthetic glenoid 12 can include glenoid 16 and humeral headprosthetic device system 14 can includehumeral head 18.Glenoid 16 can be secured to scapula bone S using any suitable means, such as a center post and a plurality of peripheral posts.Humeral head 18 can be secured to humerus bone H viacoupling device 24 that connects to ahumeral adapter 28 coupled tohumeral stem 30, as shown inFIG. 2 . - Scapula bone S and humerus bone H are typically reamed, resected or otherwise prepared to receive glenoid 16 and
humeral head 18. As can be seen,humeral head 18 can be mounted to humerus bone H such that theperimeter 20 ofhumeral head 18 can be substantially aligned withedge 22 of humerus bone H. It can be desirable forhumeral head 18 to be properly centered on humerus bone H to achieve correct anatomic operation, for example, so thathumeral head 18 can smoothly rotate against glenoid 16. As such, the size ofhumeral head 18 can be selected so that the diameter ofperimeter 20 substantially matches that ofedge 22. It is not, however, always possible forhumeral head 18 to be optimally aligned withedge 22 upon implantation. For example,humeral stem 30 and humeral adapter 28 (FIG. 2 ) are not always implanted into humerus bone H such that the neck (e.g.,neck 98A ofFIG. 4 ) for receivinghumeral head 18 is centered to align with glenoid 16. As such, the present disclosure provides a system and method for sizing, trialing and aligninghumeral head 18 with humerus bone H. -
FIG. 2 is a schematic illustration of a humeral head prosthetic device system, such assystem 10 ofFIG. 1 , implanted in humerus bone H and showingcoupling device 24 connectingprosthetic head 26 withhumeral adapter 28 andhumeral stem 30. Humerus bone H can be reamed to accepthumeral stem 30 in any suitable manner.Humeral stem 30 can include a socket for receivinghumeral adapter 28.Humeral adapter 28 can includeneck 32 for connecting tocoupling device 24. Couplingdevice 24 can be inserted intoprosthetic head 26 atsocket 34.Prosthetic head 26 can comprise or be substituted forhumeral head 18 ofFIG. 1 . - The translational and rotational position of
prosthetic head 26 relative to stem 30 can be changed to help ensure thatprosthetic head 26 aligns with the humerus bone H and with the glenoid of a scapula. In one example,coupling device 24 can have a socket forneck 32 that is offset from the center ofcoupling device 24. In another example,socket 34 inprosthetic head 26 can be offset from the center ofprosthetic head 26. Additionally, combinations of offset components can be used, as is discussed with reference toFIG. 4 . Trialing device 36 (FIGS. 3A and 3B ) can be used to select aprosthetic head 26 and acompatible coupling device 24. In another embodiment,coupling device 24 can comprise trialingdevice 36. -
FIGS. 3A and 3B are lateral and medial exploded views of trialingdevice 36 for use as, or selection of,coupling device 24 ofFIG. 2 , which shows trialinghead 38, mountingplate 40 andadapter coupling plate 42.Trialing head 38 can comprise curved articulatingsurface 44,edge perimeter 46,interior surface 48,socket 50 andaccess openings plate 40 can comprise firstmajor surface 54, secondmajor surface 56,adapter accommodation hole 58 andindicia 60. Slide posts 62A and 62B can extend from and/or through mountingplate 40.Adapter coupling plate 42 can comprise thirdmajor surface 64, fourthmajor surface 66,adapter coupling hole 68 andindicator 70. - Curved articulating
surface 44 can be shaped to approximate the shape of a natural or anatomic humeral head. Curved articulatingsurface 44 can be smooth and can have a center that substantially aligns with the center of trialinghead 38, which can comprise the center ofedge perimeter 46, which can be circular.Interior surface 48 can be flat and can be configured to face towards or abut a planar resection of humerus boneH. Trialing head 38 can includerecess 72 that can allowedge perimeter 46 to extend out pastsocket 50 to envelop or partially cover portions ofhumeral adapters FIG. 4 ). - Mounting
plate 40 can be inserted intosocket 50 such that firstmajor surface 54 faces towardaccess openings head 38. In an example,socket 50 can includemagnets 73 that assist with retaining mountingplate 40 within trialinghead 38. Firstmajor surface 54 can be flat to abut againstsurface 74 insidesocket 50.Socket 50 can be sized and configured to provide a frictional fit with the outer perimeter of mountingplate 40 that joins firstmajor surface 54 and secondmajor surface 56. The outer perimeter of mountingplate 40 can includeflats socket 50 to prevent rotation. - Slide posts 62A and 62B can extend through mounting
plate 40 so as to project therefrom. In particular, mountingplate 40 can includepost holes slide posts plate 40. Slide posts 62A and 62B can includeheads shafts shafts Stops shafts driver instrument 118 ofFIG. 8 , can engage a drive socket inhead 78A to rotateshaft 80A and to causeslide post 62A to move relative to posthole 76A via the threaded engagement. Thus,shaft 80A can be advanced intopost hole 76A to move stop 82A away from secondmajor surface 56 or can be retreated frompost hole 76B to move stop 82A towardsecond surface 56.Slide post 62B can operate in a similar manner. Thus, withadapter coupling plate 42 positioned against mountingplate 40, stops 82A and 82B can be used to pulladapter coupling plate 42 into compression with mountingplate 40 to thereby immobilizeadapter coupling plate 42 relative to mountingplate 40. - Third
major surface 64 ofadapter coupling plate 42 can be positioned against secondmajor surface 56 of mountingplate 40.Adapter coupling plate 42 can includeslots post holes Slots slide posts FIG. 3A ) movement ofadapter coupling plate 42, and can be less than the width ofstops slide posts slots slide posts FIG. 3A ) movement ofadapter coupling plate 42. -
Adapter coupling hole 68 can align withadapter accommodation hole 58.Adapter coupling hole 68 can be sized and configured to mate withneck 98A orneck 98B ofhumeral adapter 28A andhumeral adapter 28B, respectively, ofFIG. 4 .Adapter coupling hole 68 can be typically round in shape and can formwall 86 to receive the desired neck. In oneexample wall 86 can be flat and straight such thatcoupling hole 68 is cylindrical. In another example,wall 86 can be flat and angled such thatcoupling hole 68 is conical in shape. In another example,wall 86 can be arcuate such thatcoupling hole 68 is hemi-spherical in shape.Adapter accommodation hole 58 can be larger thanadapter coupling hole 68. As such, a neck extending throughadapter coupling hole 68 and intoadapter accommodation hole 58 can be moved around within the area ofadapter accommodation hole 58 asadapter coupling plate 42 slides against mountingplate 40. - When trialing
device 36 is assembled,adapter coupling plate 42 can slide against mountingplate 40 to change the position of trialinghead 38 relative tocoupling hole 68.Adapter coupling plate 42 can slide alongslide posts slots surface 44 relative to the center ofcoupling hole 68, thereby changing the offset of trialingdevice 36. In the orientation shown, the position ofcoupling hole 68 is changed in the up-and-down direction (relative to the orientation ofFIG. 3A ).Trialing device 36 can be rotated about the neck that is inserted incoupling hole 68 to allow the position ofcoupling hole 68 to be changed in the side-to-side direction (relative to the orientation ofFIG. 3A ). The relative position betweenadapter coupling plate 42 and mountingplate 40 can be marked, identified or shown usingindicia 60 andindicator 70. In particular,indicator 70 can be any feature or marking that provides a constant frame of reference onadapter coupling plate 42 and that overlaps or otherwise interacts withindicia 60. In the example ofFIGS. 3A and 3B ,indicator 70 comprises an edge offlange 87 onadapter coupling plate 42 that overlaps with hashmarks defining indicia 60. Each of the hash marks can correspond to an offset size of a prosthetic humeral head. For example, as can be seen inFIG. 6 , size A can correspond to a zero offset where the center ofcoupling hole 68 aligns with the center of curved articulatingsurface 44, with sizes B-F indicating progressively larger offsets.Indicator 70 can includemarker 88 that prompts a user where to look to take the size reading. In the example shown,marker 88 comprises an arrow pointing to the edge offlange 87 that overlaps withindicia 60. -
FIG. 4 shows an installation relationship of humeral headprosthetic device system 10 ofFIGS. 1 and 2 showing conversion ring 90 for use ascoupling device 24 and connectingprosthetic head 26 withhumeral adapters humeral stem 30. -
Humeral stem 30 can compriseshank 92 andsocket 94.Humeral adapter 28A can comprisepost 96A andneck 98A and can be configured as a fixed angle adapter.Humeral adapter 28B can comprise post 96B andneck 98B and can be configured as a variable angle adapter.Conversion ring 90 can comprisebody 100 having neck bore 102.Prosthetic head 26 can compriseouter surface 104,inner surface 106 andsocket 108. -
Humeral stem 30 can be configured in a conventional manner to be implanted into cancellous bone of a long bone. In one example,humeral stem 30 is configured to be implanted into a humerus bone wherein the humeral head has been resected. However, the systems and methods of the present disclosure are readily applicable to and adapted for use with other bones, such as femurs.Shank 92 can be inserted into the cancellous bone to anchorstem 30 within the bone in a stationary fashion.Socket 94 can remain exposed to receive one ofadapters conversion ring 90. -
Posts socket 94 ofhumeral stem 30 such thatadapters humeral stem 30. In an example, posts 96A and 96B have an oblong shape that mates with a similarly oblong shapedsocket 94. The mating oblong shapes prevent rotation ofposts stem 30.Necks posts prosthetic head 26 at a fixed angle relative to stem 30. For example, an axis extending along the center ofpost 96A is at a fixed angle relative to an axis extending along the center ofneck 98A, thereby locating the axis ofneck 98A in a fixed relationship to an axis extending along the center ofshank 92.Humeral adapter 28B can be configured in a similar manner. In other examples,humeral stem 30 can be made monolithically with either ofadapters necks -
Neck 98A can comprise a fixed angle neck such that the angle betweenprosthetic head 26 andshank 92 cannot be adjusted oncestem 30,adapter 28A andconversion ring 90 are assembled. As such, the wall surfaces ofneck 98A can be flat to engage flat surfaces of neck bore 102 ofconversion ring 90. -
Neck 98B can comprise a variable angle neck such that the angle betweenprosthetic head 26 andshank 92 can be slightly adjusted oncestem 30,adapter 28B andconversion ring 90 are assembled. As such, the wall surfaces ofneck 98B can be curved to engage curved surfaces of neck bore 102 of an embodiment ofconversion ring 90 different from the one shown inFIG. 4 . -
Conversion ring 90 comprises a component that allowsprosthetic head 26 to mate withadapters body 100 can be shaped to match the shape ofsocket 108 ofprosthetic head 26.Socket 108 andside surfaces 110 can have an asymmetric shape to prevent rotation betweenconversion ring 90 andprosthetic head 26. As shown inFIG. 4 , a central axis AB ofbody 100 can be offset from acentral axis A S 102 ofsocket 102. Thus, different conversion rings 90 can be configured with different offset distances DO to positionprosthetic head 26 in different locations relative to stem 30 for different situations, such as depending on the implantation ofstem 30 into the cancellous bone and the particular humeral head anatomy and mating glenoid anatomy or prosthetic.Trialing device 36 can be used to determine the desiredconversion ring 90 to be used in a particular implant system.Trialing device 36 can alternatively be used in place ofconversion ring 90 due to the ability ofadapter coupling plate 42 being able to equivalently shift the location of axis AS relative to axis AB. Different prosthetic heads can be coupled toconversion ring 90 to match or closely mimic the anatomy of a patient. - As discussed,
socket 108 ofprosthetic head 26 is sized and shaped to fit withside surfaces 110 ofconversion ring 90.Socket 108 can be deep enough to receive the entire thickness ofconversion ring 90 such thatinner surface 106 can be positioned in close proximity to a resected humeral surface.Prosthetic head 26 can includeouter surface 104 that can be curved or arcuate to mate with an anatomic or prosthetic glenoid cavity.Outer surface 104 defines the geometry ofprosthetic head 26. For example,prosthetic head 26 can have, in different embodiments, different thicknesses T, different diameters D and different radii R. Thus, a surgeon can intraoperatively select from among a plurality of different sized prosthetic heads 26 to find a prosthetic head that closely matches the anatomy of a particular patient. -
FIG. 5 is a front view ofhumeral head template 114 used to initially size a humeral head trial or prosthetic, such as the exemplaryhumeral head 18 ofFIG. 1 , prosthetichumeral head 26 ofFIG. 2 or trialinghumeral head 38 ofFIGS. 3A and 3B .Template 114 includesslots 116A-116P that have different geometries, such as thicknesses, diameters and radii. After a humeral head has been resected to remove a hemi-spherical-like shaped portion of the bone, the resected bone portion is positioned withindifferent slots 116A-116P in order to find the initial size of a head component that can be implanted into a that particular patient. For example, a surgeon can select which ofslots 116A-116P the resected humeral head matches closest. That particular slot can, for example, indicate to the surgeon the thickness T, diameter D and radius R of aprosthetic head 26 that can be used to closely match the anatomy of the patient. -
FIG. 6 is a perspective view of trialingdevice 36 ofFIGS. 3A and 3B assembled with trialinghead 38 and showingadapter coupling plate 42 connected to mountingplate 40 viaslide posts Trialing head 38 can be selected to match the geometry of the resected humeral head determined usingtemplate 114. Mountingplate 40 can be inserted into trialinghead 38 to secure components of trialingdevice 36 thereto. For example, the outer perimeter of mountingplate 40 can be inserted intosocket 50 of trialinghead 38 via an interference or friction fit. Slide posts 62A and 62B can be retracted further out ofpost holes adapter coupling plate 42 to slide relative to mountingplate 40 inslots adapters FIG. 4 , can be inserted intocoupling hole 68 inadapter coupling plate 42. Withslide posts coupling plate 42 into compression with mountingplate 40,coupling plate 42 can be slid against mountingplate 40 to moveedge perimeter 46 relative to resected humeral bone, as shown inFIG. 7 . -
FIG. 7 is a perspective view of trialinghead 38 ofFIG. 6 coupled to a humeral adapter (not shown for clarity) implanted into humerus bone H and illustrates multiple degrees of freedom of movement.Humeral stem 30 can be implanted into humerus bone H in a conventional manner.Humeral adapter humeral stem 30, as previously described.Adapters head 38 to trialingdevice 36. For example, post 96A ofadapter 28A can be inserted intohumeral stem 30 andneck 98A ofadapter 28A can be inserted intocoupling hole 68 ofadapter coupling plate 42. Surgeon S can move trialinghead 38 in multiple directions by sliding ofplates adapter coupling plate 42 about an axis ofneck 98A. Thus,edge perimeter 46 of trialinghead 38 can be moved relative to edge 22 of humerus bone H to position trialinghead 38 in the proper position. For example, the center of trialinghead 38 can be positioned in the center of the resected surface of humerus bone H so thatedge perimeter 46 is concentric withedge 22. - The position of trialing
head 38 relative to humerus bone H can be marked on humerus bone H using an appropriate marker. For example, as shown inFIG. 8 , the location ofmarker 117 on trialinghead 38 can be marked on humerus bone H using a surgical marker or a electrocautery, e.g. a Bovie. As shown inFIG. 9 ,marker 117 can extend through trialinghead 38, or have a corresponding mark on the opposite side, so as to be visible to a surgeon from both sides of trialinghead 38.Marker 117 can allow the surgeon to reassemble trialinghead 38 to trialingdevice 36 or reposition trialinghead 38 on trialingdevice 36 into the same position on the marked-up humerus bone H if for somereason trialing head 38 had to be removed or trialingdevice 36 needed to be repositioned. -
FIG. 8 is a perspective view of an exterior of trialinghead 38 ofFIG. 7 showing slide post 62A anddriver instrument 118 inserted into articulatingsurface 44 to adjustslide post 62B.Trialing head 38 includesaccess openings driver instrument 118 to enter the interior region of trialinghead 38 to accessslide posts Heads slide posts head 38 via mountingplate 40 to align withaccess openings device 36 so that the position of trialinghead 38 relative tocoupling plate 42 does not change. For example, with reference toFIG. 6 ,slide posts coupling plate 42 into compression with mountingplate 40, preventingcoupling plate 42 from sliding against mountingplate 40. AlthoughFIG. 8 shows trialing device 36 having a pair ofslide posts coupling plate 42 and mountingplate 40 can be configured to slide relative to each other in other arrangements in which slideposts coupling plate 42 can be configured to slide directly within a slot in mountingplate 40, and a separate fastener can be used to lock the relative positions of the plate. - In another example of the trialing devices of the present application,
coupling plate 42 can be immobilized relative to mountingplate 40 via a deformable body that can be deformed viaslide posts slots slots coupling plate 42. In other examples, other types of deformable bodies may be activated by one or more slide posts to frictionally engagecoupling plate 42 and mountingplate 40 with each other. -
FIG. 9 is an interior side view of trialingdevice 38 ofFIGS. 6-8 after adjustment, where an edge offlange 87 aligns with sizingindicia 60. In particular,edge 120 offlange 87 can align with hash marks 122A-122F to indicate the size of prosthetic to be used with the patient. As identified bycallout 124 inFIG. 9 , edge 120 offlange 87 aligns withhash mark 122C, indicating that a size C prosthetic humeral head can be used. As mentioned, size C can be offset from a zero offset position indicated byhash mark 122A. In other examples, more or fewer sizes/hashmarks can be indicated on mountingplate 40. In other examples, other types of sizing indicia or indicators can be used. For example, marks along the edges ofcoupling plate 42 alongslots plate 40. - The present subject matter can help provide a solution to various problems associated with the trialing of a humeral head by providing
trialing device 36, or a similar device such as those discussed below with reference toFIGS. 10-20F , that can be used to couplehumeral stem 30 orhumeral adapters humeral head 18 ofFIG. 1 ,prosthetic head 26 ofFIG. 2 or trialinghead 38 ofFIGS. 3A and 3B . The trialing devices described herein can be locked in place without removing the humeral head trial from the anatomy, such as by rotatingslide posts head 38 for trialingdevice 36 to ensure accurate readings are taken fromindicator 70 and sizingindicia 60 and a proper head size is selected. The trialing devices described herein can be easily assembled and disassembled, cleaned and reused, thereby minimizing the number of components and instruments that must be maintained in inventory. -
FIG. 10 is a perspective view of humeralhead trialing device 130 for use with humeral headprosthetic device system 10 ofFIG. 4 .FIG. 11 is a bottom plan view of humeralhead trialing device 130 ofFIG. 10 showing offsetslide device 132 within trialinghead 134. Humeralhead trialing device 130 is similar to humeralhead trialing device 36 ofFIGS. 3A and 3B except, for example, humeralhead trialing device 130 includes only a single fastener for locking offsetslide device 132 and humeralhead trialing device 130 slides on rails rather than posts. -
Trialing head 134 can comprise curved articulatingsurface 136,edge perimeter 138,interior surface 140,socket 142, access opening 144 andsockets slide device 132 can includeslide plate 148 andbushing 150.Slide plate 148 andbushing 150 can be coupled together usingfastener 152.Slide plate 148 andbushing 150 can operate in a similar fashion as mountingplate 40 andadapter coupling plate 42 of humeralhead trialing device 36, respectively. However, rather thanadapter coupling plate 42 sliding against mountingplate 40 in an abutting relationship, bushing 150 can include rails that are captured within channels ofslide plate 148. - As shown in
FIG. 11 ,slide plate 148 can be inserted intorecess 180 of trialinghead 134 and can be held in place by frictional interaction betweenslide plate 148 and trialinghead 134 atrecess 180.Fastener 152 can be extended into access opening 144 to engage fastener bore 164 (FIG. 12A ) inslide plate 148 to preventslide plate 148 from separating from trialinghead 134. Bushing 150 can slide between trialinghead 134 andslide plate 148 such thatindicators 156A and 156E can align withsize indicia 158A and 158E onslide plate 148.Fastener 152 can be adjusted to pullslide plate 148 toward trialinghead 134 to immobilizebushing 150. -
FIG. 12A is a cross-sectional view of humeralhead trialing device 130 ofFIG. 11 showing offsetslide device 132 having trialinghead 134,slide plate 148,bushing 150 andfastener 152.FIG. 12B is a perspective cross-sectional view of humeralhead trialing device 130 ofFIG. 11 taken offset from a center of the device to showrail 176B. -
Slide plate 148 can comprise fifthmajor surface 160, sixthmajor surface 162,fastener hole 164,first slot 166A and second slot 166B (not visible inFIGS. 12A and 12B ), andaperture 167. - Bushing 150 can comprise
first end surface 168,second end surface 170,adapter coupling hole 172,flanges 174, rails 176A (not visible inFIGS. 12A and 12B ) and 176B andledge 177. End surfaces 168 and 170 can be considered the major surfaces ofbushing 150. Bushing 150 can comprise a rectilinear body having four sides bounded byfirst end surface 168 andsecond end surface 170.Rails 176A and 176B can extend from opposite sides of the rectilinear body to engageslots 166A and 166B.Flanges 174 can extend fromfirst end surface 168 to surroundsocket 178, which can extend through the rectilinear body fromsecond end surface 170 through tofirst end surface 168.Flanges 174 can be separated by scallops or cut-outs 175 inbushing 150.Flanges 174 can comprise resilient bodies that are separated by cut-outs 175 to facilitate flexion to increase frictional engagement withneck - Curved articulating
surface 136 can be shaped to approximate the shape of a natural or anatomic humeral head. Curved articulatingsurface 136 can be smooth and can have a center that substantially aligns with the center of trialinghead 134, which can comprise the center ofedge perimeter 138, which can be circular.Interior surface 140 can be flat and can be configured to face towards or abut a planar resection of humerus boneH. Interior surface 140 can be smooth or textured. Texturing 141 ofinterior surface 140 can facilitate locking of trialinghead 134 into place via friction with the humerus bone H, thereby preventing trialinghead 134 from migrating out of position once aligned. Thetexturing 141 can comprise knurling, pointed projections, spikes, pyramids and the like.Trialing head 134 can include recess 180 that can engageslide plate 148 in order to allowedge perimeter 138 to extend out pastsocket 142 andslide plate 148 to envelop or partially cover portions ofhumeral adapters FIG. 4 ). -
Slide plate 148 can be inserted intosocket 142 atrecess 180 such that fifthmajor surface 160 faces toward access opening 144 and can thus be disposed inside of trialinghead 134. In an example,socket 142 can include magnets (e.g.,magnets 73 ofFIG. 3B ormagnets FIG. 19 ) that assist with retainingslide plate 148 within trialinghead 134. Fifthmajor surface 160 can be flat to abut againstsurface 182 insidesocket 142. Recess 180 can be sized and configured to provide a frictional fit with the outer perimeter ofslide plate 148 that joins fifthmajor surface 160 and sixthmajor surface 162. The outer perimeter ofslide plate 148 can includeflats recess 180 to prevent rotation. -
Socket 178 can be sized and configured to mate withneck 98A orneck 98B ofhumeral adapter 28A orhumeral adapter 28B, respectively, ofFIG. 4 .Socket 178 can be typically round in shape and can form a wall to receive the desired neck. In one example the wall can be flat and straight such thatsocket 178 is cylindrical. In another example, the wall can be flat and angled such thatsocket 178 is conical in shape. In another example, the wall can be arcuate such thatsocket 178 is hemi-spherical in shape. In examples, the wall can have a compound shape with two surfaces, flat or curved, angled with respect to each other.Socket 178 provides a frictional engagement with a neck of a femoral component, such asnecks adapters Socket 142 can be larger thansocket 178 so as to form a well within trialinghead 134. As such, a neck extending throughsocket 178 and intosocket 142 can be moved around within the area of trialinghead 134 asbushing 150 slides againstslide plate 148. - In examples, trialing
head 134 can be made from a metallic material,slide plate 148 can be made of a metallic material, andbushing 150 can be made of a polymer material. However, other materials and combinations of materials can be used. - With humeral stem 30 (
FIG. 4 ) inserted into a humerus bone,neck 98A orneck 98B fromhumeral adapter 28A orhumeral adapter 28B can be inserted intosocket 178 inbushing 150.Access opening 144 can align withfastener hole 164 such thatfastener 152 can be inserted through trialinghead 134 intobushing 150.Fastener 152 can includehead portion 186A andshaft portion 186B. In examples,fastener 152 can be configured to be captive within humeralhead trialing device 130 so thatfastener 152 cannot be removed. For example,fastener 152 can include a fixed washer attached tofastener 152 after assembly (e.g., via welding) to preventshaft portion 186B from being fully retracted fromfastener hole 164, or access opening 144 can include a flange that permitsfastener 152 to be inserted into trialinghead 134 but that engagehead portion 186A to preventshaft portion 186B from being fully retracted fromfastener hole 164.Fastener 152 can remain in a loosened position withhead portion 186A resting on or nearledge 177 such thatslide plate 148 is not pulled into engagement withsurface 182 via engagement between threading onfastener 152 andfastener hole 164. Withfastener 152 in a loosened position, the position of trialinghead 134 relative to the humeral bone can be adjusted. In particular, bushing 150 can slide againstslide plate 148 and trialinghead 134 can be rotated such thatbushing 150 rotates aroundneck 98A orneck 98B.Trialing head 134 can be translated by translatingrails 176A and 176B withinslots 166A and 166B ofslide plate 148, respectively.Rails 176A and 176B andslots 166A and 166B can be configured so thatslide plate 148 andbushing 150 are co-planar, or substantially co-planar, so thatbushing 150 is, for example, nested withinslide plate 148. Thus, trialinghead 134 can be located in any desired positioned relative the humeral bone by the surgeon, thereby changing the offset of humeralhead trialing device 130. Once in the desired position,fastener 152 can be changed from the loosened position to a tightened position to lock the configuration of offsetslide device 132. In examples, bushing 150 can be crushed or partially crushed betweenslide plate 148 and trialinghead 134. - A driver instrument, e.g., a screw driver or
driver instrument 118 ofFIG. 8 , can engage a drive socket inhead portion 186A to rotateshaft portion 186B and to causeslide plate 148 to draw nearer to surface 182 of trialinghead 134. Simultaneously, bushing 150 can be sandwiched between portions ofslide plate 148 and trialinghead 134 to immobilizebushing 150. For example, bushing 150 can be configured to have a surface, edge or ledge that can be pushed into an engaging surface of trialinghead 134 asfastener 152 drawsslide plate 148 closer to trialinghead 134. For example,flanges 174 can be configured to have lengths that allowend surfaces 168 offlanges 174 to be pushed intoend wall 143 ofsocket 142 asfastener 152 is tightened. Engagement betweenend surfaces 168 andend wall 143 can pushflanges 174 toward each other to collapse flanges down around aneck adapter Flanges 174, or similar features, that can collapse around a stem component neck when tightened by a fastener can be incorporated into any of the humeral head trialing devices described herein having a bore that receives the stem component neck.Shaft portion 186B can be advanced intofastener hole 164 to moveslide plate 148 towardsurface 182 and immobilizebushing 150, or can be retreated fromfastener hole 164 to retreatslide plate 148 fromsurface 182 andfree bushing 150 for translation. Thus, frictional engagement betweensocket 178 and the neck of the humeral stem component can hold the humeral stem component in engagement with offsetslide device 132 in an unlocked configuration, and frictional engagement ofsocket 178 in combination with inward pressure from collapsing offlanges 174 can hold the humeral stem component in engagement with offsetslide device 132 in a locked configuration. -
FIG. 13 is a perspective view of humeralhead trialing device 130 ofFIGS. 10-12B mounted on humerus bone H and driveinstrument 188 positioned to engagerotational features head 134. Driveinstrument 188 can engage trialinghead 134 to facilitate rotation and translation of trialinghead 134. In particular,drive instrument 188 can includetabs rotational features rotational features tabs instrument 188 can also includesurface 192 that can be shaped or contoured to engage trialinghead 134 and to permit clearance to allowtabs rotational features - When trialing
head 134 is first connected to humerus H, trialinghead 134 is free to move around. In the orientation shown inFIG. 13 , the position of access opening 144 can be changed in the up-and-down direction (relative to the orientation ofFIG. 13 ).Trialing head 134 can be rotated about an axis of the neck inserted into humeralhead trialing device 130 to allow the position of access opening 144 to be changed in the side-to-side direction (relative to the orientation ofFIG. 13 ). Once the desired position of trialinghead 134 is determined by a surgeon,driver instrument 118 ofFIG. 8 can be inserted into access opening 144 to movefastener 152 into a tightened position. The relative position between trialinghead 134 and humerus H can be marked, identified or shown usingindicator 194. For example, a surgeon can use a tool or marker to indicate on humerus H whereindicator 194 should be located in the final position for correlating a position of a humeral head implant. - It is additionally desirable to know where the maximum offset for trialing
head 134 is located onhumerus H. Indicator 194 can be located on trialinghead 134 and can be located in the same place on different trialing heads 134, in the direction wherebushing 150 is translated a maximum distance relative to slideplate 148. This allows the surgeon to mark humerus H with a surgical marker or electrocautery (e.g., a Bovie) at the tip of thearrow comprising indicator 194. The mark provided on humerus H atindicator 194 can act as a patient-specific landmark that allows the surgeon to position the final prosthetic implant so that the maximum offset of the final prosthetic implant is aligned with the mark on humerus H. This facilitates the surgeon aligning the final prosthetic implant in the same orientation as trialinghead 134. Without a landmark provided on humerus H at indicator 194 a surgeon would have to estimate from memory or anatomic indications by spinning the implant until it appears to be in the same orientation as the trial, which can take more time and is not always as accurate. Furthermore, the final prosthetic implant could be prematurely locked into place while the surgeon is determining a position for the final prosthetic implant. For example, a Morse taper could prematurely engage. - Humeral
head trialing device 130 can be removed fromhumeral adapter 28 and the relative position betweenbushing 150 andslide plate 148 can be shown, identified, marked, and/or recorded. In particular, with reference toFIG. 11 ,indicators 156A and 156B can align withsize indicia Indicators 156A and 156B can be any feature or marking that provides a constant frame of reference onslide plate 148 and that overlaps or otherwise interacts withindicia indicia FIG. 11 , size A can correspond to a zero offset where the center ofsocket 178 aligns with the center of curved articulatingsurface 136, with sizes B-F indicating progressively larger offsets.Indicators 156A and 156B can include markers that indicate to a user where to look to take the size reading. In the example shown,indicators 156A and 156B comprise arrows pointing toindicia -
FIG. 14A is an exploded view of an alternative embodiment of the humeralhead trialing device 130 ofFIGS. 10-12B wherebushing 150 includesslots rails slide plate 148. Humeralhead trialing device 130 ofFIG. 14A is substantially the same as that ofFIGS. 12A and 12B except that hushing 150 includesslots rails 176A and 176B, andslide plate 148 includesrails slots 166A and 166B. - As can be seen in
FIG. 14A ,fastener 152 can be configured to not pass throughbushing 150. As will be discussed with reference toFIG. 14C ,fastener 152 can be tightened to drawslide plate 148 toward trialinghead 134 tosandwich bushing 150 between surfaces of trialinghead 134 andslide plate 148 to lock the relative positions ofbushing 150 andslide plate 148. -
Rails wider portions narrower portions bushing 150 torails Slots wider portions narrower portions bushing 150. For example, bushing 150 can be angled with respect to slideplate 148 to allowwider portions slots Narrower portions rails slide plate 148.Wider portions wider portions narrower portions rails narrower portions wider portions Rails slots aperture 167.Rails slots slide plate 148 andbushing 150 are co-planar, or substantially co-planar, so thatbushing 150 is, for example, nested withinslide plate 148. -
FIG. 14B is a perspective view of trialinghead 134 used in humeralhead trialing device 130 ofFIG. 14A showing socket 142 andrecess 180 for receivingbushing 150 andslide plate 148.Recess 180 is configured to mate with the edge ofslide plate 148 so that offsetslide device 132 can be tightly fit intorecess 180.Flats recess 180 along with corresponding flats onslide plate 148 prevent offsetslide device 132 from rotating withinrecess 180. Whenslide plate 148 is seated inrecess 180, sixthmajor surface 162 can abut surface 182 of trialinghead 134. Additionally, access opening 144 can align withfastener hole 164.Fastener 152 can be inserted into access opening 144, passed throughledge 177 in trialinghead 134 and threaded intofastener hole 164. -
FIG. 14C is a cross-sectional view of humeralhead trialing device 130 ofFIG. 14A showing interacting forces generated byfastener 152.Fastener 152 is threaded down intofastener hole 164 as shown by arrow A1 to bringhead portion 186A into contact withledge 177 at callout C1. Additional threading or tightening ofshaft portion 186B causesslide plate 148 to move upward, as shown by arrow A2.Slide plate 148 is then pushed upward againstsurface 182 as shown in callout C2. Sixthmajor surface 162 can includeplatform 193 that is elevated from a remaining portion of sixthmajor surface 162.Platform 193 can act as a lever mechanism whenfastener 152 drawsslide plate 148 towardsurface 182. For example,slide plate 148 will rotate atplatform 193 asfastener hole 164 is drawn closer tosurface 182, which can cause the end ofslide plate 148 opposite ofplatform 193 to rotate towardsurface 182, as shown by arrow A3. The lever action provided byplatform 193 can improve the friction force that clamps down againstbushing 150 by causing both ends ofslide plate 148 to be drawn in tight tosurface 182. The lever action additionally can preventslide plate 148 from rocking or rotating aboutbushing 150, which can interfere with alignment between humeralhead trialing device 130 and a humeral stem component. As mentioned,bushing 150 can include cut-outs 175 to formflanges 174 that permitbushing 150 to flex and receiveneck -
FIG. 15A is a top perspective view of humeralhead trialing device 200 for use with humeral headprosthetic device system 10 ofFIG. 4 .FIG. 15B is a bottom perspective view of humeralhead trialing device 200 ofFIG. 15A showing offsetslide device 202 within trialinghead 204. - Humeral
head trialing device 200 is similar to other humeral head trialing device described herein and can be used with features described with reference to the other embodiments. Humeralhead trialing device 200 can includefastener 206 for locking offsetslide device 202. -
Trialing head 204 can comprise curved articulatingsurface 208,edge perimeter 210 havingscallops 212,interior surface 214,socket 216 andaccess opening 218. Offsetslide device 202 can include trial offsetplate 220 and trial offsetslide 222. Trial offsetplate 220 and trial offsetslide 222 can be coupled together usingfastener 206. Trial offsetplate 220 and trial offsetslide 222 can operate in a similar fashion as mountingplate 40 andadapter coupling plate 42 of humeralhead trialing device 36, respectively. However, rather thanadapter coupling plate 42 sliding against mountingplate 40 in an abutting relationship, trial offsetslide 222 can include rails that are captured within channels of trial offsetplate 220. - Trial offset
plate 220 is inserted intosocket 216 of trialinghead 204 and can be held in place by frictional interaction between trial offsetplate 220 and trialinghead 204 atsocket 216.Fastener 206 can be extended into access opening 218 to engagefastener bore 224 in trial offsetplate 220 to prevent trial offsetplate 220 from separating from trialinghead 204. Trial offsetslide 222 can slide between trialinghead 204 and trial offsetplate 220 such thatindicators size indicia plate 220.Fastener 206 can be adjusted to immobilize trial offsetslide 222 relative to trial offsetplate 222. -
FIG. 16 is a top perspective view of a first embodiment of offsetslide device 220 including a trial offsetplate 220, trial offsetslide 222 andfastener 206. - Trial offset
plate 220 can include seventhmajor surface 230, eighthmajor surface 232,flats aperture 236,slots FIG. 20A ),cutouts post 242 and fastener bore 224 (FIG. 15 ). Trial offsetslide 222 can include ninthmajor surface 244, tenthmajor surface 246,flats rails cutouts - Trial offset
plate 220 can be configured to be positioned withinsocket 216 of trialing head 204 (FIG. 15 ).Flats plate 220 from rotating withinsocket 216.Aperture 236 can be configured to receive trial offsetslide 222 and can comprise a U-shaped cut-out in trial offsetplate 220.Aperture 236 can be partially bounded bycrosspiece 258 on which post 242 can be disposed.Aperture 236 can includeslots cutouts slide 222. -
Rails slide 222 can be inserted intoslots Rails slots slide 222 co-planar, or substantially co-planar, with trial offsetplate 220 such that trial offsetslide 222 can be nested within trial offsetplate 220.Rails slots cutouts cutouts slide 222. - In the centered position, as shown in
FIG. 16 , trial offsetslide 222 is positioned all the way to the right (with respect to the orientation ofFIG. 16 ) such thatnotch 256 engagespost 242. The centered position is also shown inFIGS. 20A and 20B . Withnotch 256 and post 242 engaged, a portion ofrails slots slide 220 is supported within trial offsetplate 220.Fastener 206 can be threaded intopost 242 atfastener bore 224.Fastener 206 can includehead 260 that can includeflange 262 that can press down on trial offsetslide 222 to press trial offsetslide 222 againstcrosspiece 258, thereby immobilizing trial offsetslide 222. - Trial offset
slide 222 can be moved away from the centered position ofFIG. 16 to a plurality of offset positions by moving trial offsetslide 222 to the left (with respect to the orientation ofFIG. 16 ). A partially offset position is shown inFIG. 20C . In a fully offset position,aperture 236 andcutouts end 264 andcutouts rails slots end 264 directly engagingaperture 236, trial offsetslide 222 can be positioned away frompost 242. However trial offsetslide 222 can remain supported bycrosspiece 258 such thathead 260 andflange 262 offastener 206 can push trial offsetslide 222 againstcrosspiece 258 to immobilize trial offset slide 222 (SeeFIG. 20C ). As shown inFIG. 15 , trial offsetslide 222 can be positioned to align one ofindicators size indicia Indicators slide 222. As discussed above, one of sizes A-F can be selected byindicators size indicia -
FIG. 17 is a top perspective view of a second embodiment of offsetslide device 202 including trial offsetplate 220 and trial offsetslide 222 withbushing 266. Trial offsetplate 220 ofFIG. 17 can function in the same manner as that ofFIG. 16 except that coupling bore 250 is provided withbushing 266. Bushing 266 can function as a liner to coupling bore 250 that facilitates engagement with an adapter neck, such asneck 98A orneck 98B ofhumeral adapter 28A andhumeral adapter 28B, respectively. Trial offsetslide 222 can be made of a rigid metallic material andbushing 266 can be comprised of a resilient material, such as a plastic or polymer. Bushing 266 can soften the engagement with the humeral adapter, prevent damage to the humeral adapter and facilitate affixation to the humeral adapter. Bushing 266 can includeaxial portion 268 that extends across coupling bore 250 and one ormore flange portions 270 that can extend radially across ninth and tenthmajor surfaces coupling bore 250. - Bushing 266 can be configured as a separate piece that can be installed into and removed from trial offset
slide 222. Thus, abushing 266 having a different sized axial portion 268 (e.g., a different diameter socket) can be swapped into and out of trial offsetslide 222. Additionally, other bushing components can be attached to trial offsetslide 222, such as those including a projection feature (e.g., a projection feature similar to projection feature 272 ofFIG. 18 ) instead of a socket can be attached to trial offsetslide 222. -
FIG. 18 is a bottom perspective view of a third embodiment of offsetslide device 202 including trial offsetplate 220 and trial offsetslide 222 withprojection feature 272. Trial offsetplate 220 ofFIG. 18 can function in the same manner as that ofFIG. 16 except that coupling bore 250 is provided withprojection feature 272.Projection feature 272 can includecylindrical portion 272A andend wall 272B.Projection feature 272 can be solid or hollow.Projection feature 272 can function to interact with a female socket on a humeral adapter or humeral stem, such ashumeral adapter 28A,humeral adapter 28B, orhumeral stem 30. In various examples,projection feature 272 can be integral with trial offsetslide 222 and coupling bore 250 such thatcylindrical portion 272A extends from tenthmajor surface 246. In additional examples,projection feature 272 can be a separate component from trial offsetslide 222 that can be mated withcoupling bore 250. As examples,projection feature 272 can be inserted into coupling bore 250 from ninthmajor surface 244 so thatcylindrical portion 272A can extend through trial offsetslide 222 and beyond tenthmajor surface 246. Additionally,projection feature 272 can be threaded into ninthmajor surface 244 at oradjacent coupling bore 250. -
Projection feature 272, or a similar feature, can be included in any of the humeral head trialing devices described herein. For example,adapter coupling hole 68 ofFIGS. 3A and 3B can include a cylindrical portion projecting fromadapter coupling plate 42 and an end wall closing off the cylindrical portion. Likewise,socket 178 ofFIG. 11 , coupling bore 250 ofFIG. 16 andbushing 266 ofFIG. 17 can include a projection feature similar toprojection feature 272. -
FIG. 19 is a bottom view of trialinghead 204 ofFIGS. 15A and 15B showing trial mechanism well 274,scallops 212, anti-rotation features 276A and 276B, and retention features 280A and 280B. -
Edge perimeter region 210 can includescallops 212 that can act as gripping features to facilitate rotation of trialinghead 204 by a surgeon. For example,scallops 212 can increase friction between trialinghead 204 and a hand of the surgeon to allow trialinghead 204 to be rotated on the neck of the adapter to which it is mounted (seeFIG. 20D ). Although depicted as semi-circular scallops,edge perimeter region 210 and trialinghead 204 can include other gripping features with different shapes. For example,edge perimeter 210 can be provided with scoring, crenellations, knurling and the like. Additionally, trialinghead 204 can be provided with other rotational features that facilitate gripping and rotating of trialinghead 204 by a surgeon. For example, trialinghead 204 can include various sockets (e.g.,sockets FIG. 10 ) to facilitate coupling with a tool (e.g.,instrument 188 ofFIG. 13 ). Furthermore, trialinghead 204 could include ahex socket 213 at its center to mate with a driver instrument, such as a hex key, an Allen wrench or the like. - Trial mechanism well 274 can comprise a thinned portion of trialing
head 204, e.g., a portion of trial mechanism well 274 that has a thickness that is smaller than other portions of trial mechanism well 274, to provides space within trialinghead 204 to accommodate offsetslide device 202. Trial mechanism well 274 can be smaller thansocket 216 to allow trial offsetplate 220 to be tightly fit with trialinghead 204. Trial mechanism well 274 can be located opposite coupling bore 250 when assembled with offsetslide device 202 and can be wide enough to allow coupling bore 250 to move from the centered position ofFIG. 20B to various offset positions, such as shown inFIG. 20C , with a humeral adapter neck inserted therein. Trial mechanism well 274 can be deep enough to accommodate the neck of the adapter inserted intocoupling bore 250, as well as anyprojection feature 272 that can be extended fromcoupling bore 250. Trial mechanism well 274 can include pocket 278 that can be included to provide space forhead 260 andflange 262 offastener 206.Pocket 278 need not be contiguous with trial mechanism well 274.Pocket 278 can thus be provided at the location of access opening 218, andpocket 278 can surroundaccess opening 218. -
Inner surface 281 of trialinghead 204 can include retention features 280A and 280B. Retention features 280A and 280B can be configured to assist with holding trial offsetplate 220 withinsocket 216 in addition to or alternatively to any frictional fit or press fit forces provided by the interaction of trial offsetplate 220 andpocket 216. For example,pocket 216 can be shaped to have approximately the same outer perimeter shape as trial offsetplate 220 to hold trial offsetplate 220 snuggly in place. However, in order to facilitate insertion of trial offsetplate 220 so that, for example, a surgeon does not have to force trial offsetplate 220 intopocket 216, trialinghead 204 can be provided with other features to hold trial offsetplate 220 in place. Retention features 280A and 280B can comprise magnets that are embedded intoinner surface 281 of trialinghead 204. In examples where trial offsetplate 220 is fabricated from metal materials, the magnets of retention features 280A and 280B can hold onto trial offsetplate 220. Retention features 280A and 280B can be press fit into sockets withininner surface 281 and can be additionally or alternatively held in place with adhesive. In other examples, retention features 280A and 280B can comprise adhesive pads deposited ontoinner surface 281 to hold onto trial offsetplate 220 by adhesive forces. -
FIG. 20A is a partially exploded view of humeralhead trialing device 200 ofFIGS. 15A and 15B showing offsetslide device 202 ofFIGS. 15 and 16 positioned relative to trial mechanism well 274 of trialinghead 204 ofFIGS. 15 and 19 . In order to assemble offsetslide device 202 with trialinghead 204, trial offsetplate 220 can be aligned to be generally parallel tointerior surface 214 of trialinghead 204. Trial offsetplate 220 can also be aligned withsocket 216 such that the shape of trial offsetplate 220 aligns with the shape ofsocket 216. Trial offsetplate 220 can then be inserted intosocket 216 with trial offsetslide 222 already coupled to trial offsetplate 220. With trial offsetplate 220 inserted intosocket 216, retention features 280A and 280B can couple to trial offsetplate 220 to prevent trial offsetplate 220 from dislodging fromsocket 216. -
FIG. 20B is a perspective view of humeralhead trialing device 200 ofFIGS. 15A and 15B showing offsetslide device 202 ofFIG. 20A inserted into trial mechanism well 274. As shown, trial offsetslide 222 can be positioned partially behind trial offsetplate 220 so that trial offsetslide 222 cannot be separated from humeralhead trialing device 200 when assembled. In particular, rails 252A and 252B can be retained withinslots FIG. 16 ), respectively, to contain trial offsetslide 222. Trial offsetslide 222 is shown in the centered position whereindicator 226A aligns with one ofsize indicia 228A that corresponds to a centered position of trialinghead 204, which can comprise “size A” as discussed above.Fastener 206 can be set to a loosened position to permit trial offsetslide 222 to slide within trial offsetplate 220. -
FIG. 20C is a bottom plan view of humeralhead trialing device 200 ofFIGS. 15A and 15B showing trial offsetslide 222 translated withinslots plate 220 to exposenotch 256. Trial offsetslide 222 is translated away from the centered position ofFIG. 20B to an offset position whereindicator 226A aligns with one ofsize indicia 228A, which can comprise “size E” as discussed above.Flange 262 offastener 206 can extend beyondcrosspiece 258 to overlap with portions of trial offsetslide 222 atnotch 256. Thus, trial offsetslide 222 can be locked into position relative to trial offsetplate 220 by tightening offastener 206.Fastener 206 can be positioned onpost 242 andflange 262 can be sized to engage trial offsetslide 222 even whenend 264 is positioned toabut aperture 236.Fastener 206 can remain in a loosened position to permit trial offsetslide 222 to slide within trial offsetplate 220 so that trialinghead 204 can be adjusted relative to a humeral stem implant. -
FIG. 20D is a perspective view of humeralhead trialing device 200 ofFIGS. 15A and 15B showing offsetslide device 202 aligned withneck 282 ofhumeral stem 284.Neck 282 can be inserted into coupling bore 250 in order to seat humeralhead trialing device 200 ontohumeral stem 284.Humeral stem 284 can includeflange 286 that can be configured to be positioned proximate a resected humeral bone surface.Trialing head 204 can be positioned relative to flange 286 by rotating coupling bore 250 aboutneck 282 and translating trial offsetslide 222 relative to trial offsetplate 220. -
FIG. 20E is a front plan view of humeralhead trialing device 200 ofFIGS. 15A and 15B attached tohumeral stem 284 to illustrate rotational and translational movement capabilities of trialinghead 204.Edge perimeter 210 can approximately match the circumference offlange 286. Thus, when coupling bore 250 of trial offsetslide 222 is centered relative to trialinghead 204,edge perimeter 210 can approximately overlap with the edge offlange 286. In other words, the centers of trialinghead 204, coupling bore 250 andflange 286 can all be aligned so that trialinghead 204 can completely coverflange 286. However, using offsetslide device 202, trialinghead 204 can be rotated in clockwise and counterclockwise directions, as shown by arrows A4 and A5, and can be translated in two directions along a midline of trialinghead 204 through whichfastener 206 passes, as shown by arrow A6, to reposition the center of trialinghead 204 relative to flange 286, which can partially uncover portions offlange 286. -
FIG. 20F is a front plan view of humeralhead trialing device 200 ofFIGS. 15A and 15B showing trialing head 204 rotated and translated from the position ofFIG. 20E .Trialing head 204 is shown rotated approximately ninety degrees from the position ofFIG. 20E and then translated down and to the left (relative to the orientation ofFIGS. 20E and 20F ) to expose a tight-hand portion offlange 286. The combination of rotation provided bycoupling bore 250 and the translation provided by trial offsetslide 222 can allow the center of trialinghead 204 to be positioned anywhere within an offset radius of the center offlange 286. The offset radius can be determined by the stroke length of trial offsetslide 222 from the centered position the position ofFIG. 20B ) to the maximum offset position whereend 264 abuts aperture 236 (SeeFIG. 20C ). - Example 1 can include or use subject matter such as a system for aligning a prosthetic head component with a prosthetic stem, the system can comprise: a mounting plate that can comprise: a first major surface; a second major surface opposing the first major surface; an adapter accommodation hole extending through from the first major surface to the second major surface; and sizing indicia located on the second major surface; a first fastener extending from the mounting plate; and an adapter coupling plate slidably engaged with the mounting plate, the adapter coupling plate can comprise: a third major surface facing in a direction of the first major surface; a fourth major surface opposing the third major surface; an adapter coupling hole extending through from the third major surface to the fourth major surface, the adapter coupling hole surrounded by the adapter accommodation hole; and an indicator located on the fourth major surface to point to various portions of the sizing indicia as the adapter coupling plate slides against the mounting plate at the first slot.
- Example 2 can include, or can optionally be combined with the subject matter of Example 1, to optionally include the prosthetic head component, the prosthetic head component can comprise: an outer curved surface for approximating an anatomic articulation surface of an anatomic head; and an inner surface having a cavity that accepts the first major surface of the mounting plate.
- Example 3 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 or 2 to optionally include a fastener that can extend into the prosthetic head component so as to be accessible from the outer curved surface.
- Example 4 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 3 to optionally include a prosthetic head component that can include a first access hole in the outer curved surface aligned with the first fastener.
- Example 5 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 4 to optionally include a stem adapter that can comprise: a body for engaging a socket of the prosthetic stem; and a neck extending from the body frictionally engaged with the adapter coupling hole and passing freely into the adapter accommodation hole.
- Example 6 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 5 to optionally include a prosthetic stem, wherein the prosthetic stein can comprise a humeral stem and the prosthetic head component comprises a humeral head.
- Example 7 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 6 to optionally include a magnet located in the cavity to engage the first major surface of the mounting plate.
- Example 8 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 7 to optionally include a mounting plate that is friction fit into the cavity of the prosthetic head component.
- Example 9 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 8 to optionally include a first deformable sleeve to engage the first fastener.
- Example 10 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 9 to optionally include an outer curved surface of the prosthetic head component that includes a rotational feature.
- Example 11 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 10 to optionally include a rotational feature that comprises scallops disposed around a periphery of the outer curved surface.
- Example 12 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 11 to optionally include a rotational feature that comprises a socket disposed in the outer curved surface.
- Example 13 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 12 to optionally include an inner surface of the prosthetic head component that is textured to increase frictional engagement with bone.
- Example 14 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 13 to optionally include a first fastener that is threaded into the mounting plate and passes through the adapter coupling plate.
- Example 15 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 14 to optionally include an adapter coupling plate that can includes a first slot extending through from the third major surface to the fourth major surface and through which the first fastener extends.
- Example 16 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 15 to optionally include a first fastener that can include a stop to prevent the adapter coupling plate from separating from the first fastener.
- Example 17 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 16 to optionally include a second fastener extending from the mounting plate, wherein the first and second fasteners are threaded into the mounting plate and the adapter coupling plate is slidably along the first and second fasteners.
- Example 18 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 17 to optionally include each of the first and second slide posts comprising: a shaft threadably engaged with the mounting plate; an engagement head located proximate the first major surface of the mounting plate; and a stop located proximate the fourth major surface of the adapter coupling plate.
- Example 19 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 18 to optionally include a mounting plate that is slidably engaged with the adapter coupling plate via a tongue and groove system.
- Example 20 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 19 to optionally include a tongue and groove system comprising: a pair of rails extending from the adapter coupling plate; and a pair of slots extending in the mounting plate.
- Example 21 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 20 to optionally include a tongue and groove system comprising: a pair of rails extending from the mounting plate; and a pair of slots extending in the adapter coupling plate.
- Example 22 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 21 to optionally include a third major surface of the adapter coupling plate that is spaced apart from the first major surface of the mounting plate.
- Example 23 can include or use subject matter such as a system for aligning a prosthetic head component with a prosthetic stem, the system can comprise: a mounting plate; a slide post extending through the mounting plate in an adjustable manner; a prosthetic head component stationarily coupled to the mounting plate, the prosthetic head component having an access hole aligned with the slide post; and an adapter coupling plate slideably engaged with the mounting plate via the slide post; wherein the slide post can be adjusted from an exterior of the prosthetic head component through the access hole to immobilize the adapter coupling plate relative to the mounting plate.
- Example 24 can include, or can optionally be combined with the subject matter of Example 23, to optionally include a set of size indicators located on the mounting plate; and a pointer located on the adapter coupling plate; wherein the pointer points to different size indicators as the adapter coupling plate slides against the mounting plate.
- Example 25 can include, or can optionally be combined with the subject matter of one or any combination of Examples 23 or 24 to optionally include a slide post that can be adjusted to lock a position of the adapter coupling plate relative to the mounting plate.
- Example 26 can include, or can optionally be combined with the subject matter of one or any combination of Examples 23 through 25 to optionally include a slide post that is threaded into the mounting plate, the slide post extending through a slot in the adapter coupling plate; a set of size indicators that comprise hash marks located on a surface of the mounting plate facing away from the prosthetic head; and a pointer that can comprise a portion of the adapter coupling plate that can align with each of the hash marks depending on a position of the adapter coupling plate relative to the mounting plate.
- Example 27 can include or use subject matter such as a system for aligning a prosthetic head component with a prosthetic stem, the system can comprise: a mounting plate; a fastener extending from the mounting plate in an adjustable manner; a prosthetic head component stationarily coupled to the mounting plate, the prosthetic head component having an access hole aligned with the fastener; an adapter coupling plate; and a tongue and groove system slideably connecting the mounting plate and the adapter coupling plate; wherein the fastener can be adjusted from an exterior of the prosthetic head component through the access hole to immobilize the adapter coupling plate relative to the mounting plate.
- Example 28 can include, or can optionally be combined with the subject matter of Example 27, to optionally include a set of size indicators located on the mounting plate; and a pointer located on the adapter coupling plate; wherein the pointer points to different size indicators as the adapter coupling plate slides against the mounting plate.
- Example 29 can include, or can optionally be combined with the subject matter of one or any combination of Examples 27 or 28 to optionally include a fastener can be adjusted to bring the mounting plate closer to the prosthetic head component to squeeze the adapter coupling plate between the mounting plate and the prosthetic head component.
- Example 30 can include, or can optionally be combined with the subject matter of one or any combination of Examples 27 through 29 to optionally include a collar extending from the adapter coupling plate, the collar including flanges to receive a neck of a stem adapter, wherein the flanges have a length that configures the flanges to be pushed into the prosthetic head component when the fastener is adjusted to bring the mounting plate closer to the prosthetic head component.
- Example 31 can include, or can optionally be combined with the subject matter of one or any combination of Examples 27 through 30 to optionally include an adapter coupling plate and a mounting plate that are co-planar; and an adapter coupling plate that is thicker than the mounting plate.
- Example 32 can include or use subject matter such as a method for aligning a prosthetic head component with a prosthetic stem, the method can comprise: attaching a mounting plate of a trialing device to a prosthetic head component, the trialing device further including an adapter coupling plate; inserting a neck of a prosthetic stem into the adapter coupling plate; sliding the mounting plate of the trialing device relative to the adapter coupling plate to a adjust a position of the prosthetic head component relative to the neck of the prosthetic stem; and from outside of the prosthetic head, adjusting a fastener connected to the mounting plate to immobilize a position of the adapter coupling plate to lock the position.
- Example 33 can include, or can optionally be combined with the subject matter of Example 32, to optionally include sliding the adapter coupling plate against the fastener.
- Example 34 can include, or can optionally be combined with the subject matter of one or any combination of Examples 32 or 33 to optionally include sliding slots of the adapter coupling plate along rails of the mounting plate.
- Example 35 can include, or can optionally be combined with the subject matter of one or any combination of Examples 32 through 34 to optionally include inserting an instrument through the prosthetic head component to adjust the fastener and lock the position.
- Example 36 can include, or can optionally be combined with the subject matter of one or any combination of Examples 32 through 35 to optionally include removing the trialing device from the neck; and reading a prosthetic size indication from the trialing device after adjusting the post and locking the position.
- Example 37 can include, or can optionally be combined with the subject matter of one or any combination of Examples 32 through 36 to optionally include implanting the prosthetic stem component into a bone before inserting the neck of the prosthetic stem into the adapter coupling plate.
- Each of these non-limiting examples can stand on its own, or can be combined in various permutations or combinations with one or more of the other examples.
- The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.
- In the event of inconsistent usages between this document and any documents so incorporated by reference, the usage in this document controls.
- In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.
- The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.
Claims (20)
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US20210338451A1 (en) * | 2020-05-01 | 2021-11-04 | Ensemble Orthopedics, Inc. | Implantable interpositional orthopedic pain management |
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CN110087586B (en) | 2016-12-21 | 2021-11-09 | 拜欧米特制造有限责任公司 | Method and apparatus for trialing humeral head |
US11678993B2 (en) | 2020-02-19 | 2023-06-20 | Howmedica Osteonics Corp. | Humeral head trial with flexure |
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US20180168815A1 (en) | 2018-06-21 |
EP3558171A1 (en) | 2019-10-30 |
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WO2018118878A1 (en) | 2018-06-28 |
CN110087586A (en) | 2019-08-02 |
CN110087586B (en) | 2021-11-09 |
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